Provider Demographics
NPI:1841390119
Name:ERIE SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:ERIE SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-483-6655
Mailing Address - Street 1:1400 W MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9088
Mailing Address - Country:US
Mailing Address - Phone:419-483-6655
Mailing Address - Fax:419-483-6699
Practice Address - Street 1:278 BENEDICT AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2399
Practice Address - Country:US
Practice Address - Phone:419-668-6655
Practice Address - Fax:419-663-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7368728OtherAETNA
OH2631209Medicaid
OH342172901001OtherTRICARE
OH2631209Medicaid
OH=========01OtherBUREAU OF WORKERS COMP
OH7368728OtherAETNA