Provider Demographics
NPI:1760453690
Name:PITTSBURGH SURGICAL ASSOCIATION
Entity Type:Organization
Organization Name:PITTSBURGH SURGICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-363-8811
Mailing Address - Street 1:5750 CENTRE AVENUE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206
Mailing Address - Country:US
Mailing Address - Phone:412-363-8811
Mailing Address - Fax:412-363-8701
Practice Address - Street 1:5750 CENTRE AVENUE
Practice Address - Street 2:SUITE 430
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206
Practice Address - Country:US
Practice Address - Phone:412-363-8811
Practice Address - Fax:412-363-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015680E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090363OtherHIGHMARK BLUE CROSS
PA0675882Medicaid
PWC27972Medicare UPIN
PA031115E7XMedicare ID - Type Unspecified