Provider Demographics
NPI:1578530606
Name:SURGICENTER ASSOCIATES, INC
Entity Type:Organization
Organization Name:SURGICENTER ASSOCIATES, INC
Other - Org Name:LOWRY SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-527-2885
Mailing Address - Street 1:1117 LOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3074
Mailing Address - Country:US
Mailing Address - Phone:724-527-2885
Mailing Address - Fax:
Practice Address - Street 1:1117 LOWRY AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3074
Practice Address - Country:US
Practice Address - Phone:724-527-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05461500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391047Medicare ID - Type Unspecified