Provider Demographics
NPI:1659408300
Name:CENTRE AVENUE GROUP, LLC
Entity Type:Organization
Organization Name:CENTRE AVENUE GROUP, LLC
Other - Org Name:EAST SIDE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO,
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLIC
Authorized Official - Suffix:
Authorized Official - Credentials:CPA,, ESQ
Authorized Official - Phone:412-661-5500
Mailing Address - Street 1:5800 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3710
Mailing Address - Country:US
Mailing Address - Phone:412-661-5500
Mailing Address - Fax:
Practice Address - Street 1:5800 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3710
Practice Address - Country:US
Practice Address - Phone:412-661-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical