Provider Demographics
NPI:1255564175
Name:SURGICAL CRITICAL CARE ASSOCIATES
Entity type:Organization
Organization Name:SURGICAL CRITICAL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:FUAD
Authorized Official - Last Name:MUAKKASSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-344-6776
Mailing Address - Street 1:400 WABASH AVE
Mailing Address - Street 2:STE. 371 ACC
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2433
Mailing Address - Country:US
Mailing Address - Phone:330-344-6776
Mailing Address - Fax:330-996-2850
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:STE. 371 ACC
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6776
Practice Address - Fax:330-996-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSU9384821Medicare PIN