Provider Demographics
NPI:1831119759
Name:LAUREL SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:LAUREL SURGICAL ASSOCIATES LLC
Other - Org Name:LAUREL SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-552-0068
Mailing Address - Street 1:348 DONOHOE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6988
Mailing Address - Country:US
Mailing Address - Phone:724-522-0068
Mailing Address - Fax:724-522-0130
Practice Address - Street 1:348 DONOHOE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6988
Practice Address - Country:US
Practice Address - Phone:724-522-0068
Practice Address - Fax:724-522-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17351501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011500600001Medicaid
PA1011500600001Medicaid