Provider Demographics
NPI:1013174283
Name:FAYETTE SPECIALTY ASSOCIATES SURGICAL SERVICES
Entity Type:Organization
Organization Name:FAYETTE SPECIALTY ASSOCIATES SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-430-5797
Mailing Address - Street 1:211 EASY ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3129
Mailing Address - Country:US
Mailing Address - Phone:724-434-1660
Mailing Address - Fax:724-434-1659
Practice Address - Street 1:211 EASY ST
Practice Address - Street 2:SUITE 224
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3129
Practice Address - Country:US
Practice Address - Phone:724-434-1660
Practice Address - Fax:724-434-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434294208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty