Provider Demographics
NPI:1972687242
Name:MUNCIE SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:MUNCIE SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-289-6381
Mailing Address - Street 1:2525 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3409
Mailing Address - Country:US
Mailing Address - Phone:765-289-6381
Mailing Address - Fax:765-289-3883
Practice Address - Street 1:2525 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3409
Practice Address - Country:US
Practice Address - Phone:765-289-6381
Practice Address - Fax:765-289-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB3113OtherRAILROAD MEDICARE
CB3113OtherRAILROAD MEDICARE