Provider Demographics
NPI:1659535284
Name:MONTGOMERY COUNTY SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:217-324-8730
Mailing Address - Street 1:725 SAINT FRANCIS WAY
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1780
Mailing Address - Country:US
Mailing Address - Phone:217-324-8730
Mailing Address - Fax:
Practice Address - Street 1:725 SAINT FRANCIS WAY
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1780
Practice Address - Country:US
Practice Address - Phone:217-324-8730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121436261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service