Provider Demographics
NPI:1568418846
Name:COMMUNITY CARE SURGERY PC
Entity Type:Organization
Organization Name:COMMUNITY CARE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-282-6523
Mailing Address - Street 1:301 E BRADY ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4815
Mailing Address - Country:US
Mailing Address - Phone:724-282-6523
Mailing Address - Fax:724-282-7560
Practice Address - Street 1:301 E BRADY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4815
Practice Address - Country:US
Practice Address - Phone:724-282-6523
Practice Address - Fax:724-282-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA838595Medicare ID - Type UnspecifiedMEDICARE