Provider Demographics
NPI:1982655916
Name:ASSOCIATED SURGICAL SUPPLY
Entity Type:Organization
Organization Name:ASSOCIATED SURGICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:570-339-4001
Mailing Address - Street 1:31 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-2179
Mailing Address - Country:US
Mailing Address - Phone:570-339-4171
Mailing Address - Fax:570-339-4955
Practice Address - Street 1:31 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2179
Practice Address - Country:US
Practice Address - Phone:570-339-4171
Practice Address - Fax:570-339-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00282557OtherHIGHMARK BLUE SHIELD
PA0005628600002Medicaid
PA39HA16OtherCAPITAL BLUE CROSS
PA0429160001Medicare ID - Type UnspecifiedPROVIDER #