Provider Demographics
NPI:1548240633
Name:NORTH SHORE AMBULATORY SURGICAL
Entity Type:Organization
Organization Name:NORTH SHORE AMBULATORY SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-231-0200
Mailing Address - Street 1:2 ALLEGHENY CTR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5402
Mailing Address - Country:US
Mailing Address - Phone:412-231-0200
Mailing Address - Fax:412-231-0613
Practice Address - Street 1:2 ALLEGHENY CTR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5402
Practice Address - Country:US
Practice Address - Phone:412-231-0200
Practice Address - Fax:412-231-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4271500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0164OtherBLUE SHIELD
PA301675Medicare ID - Type Unspecified