Provider Demographics
NPI:1295743243
Name:WHITE ROSE SURGICAL ASSOCIATES LTD
Entity type:Organization
Organization Name:WHITE ROSE SURGICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:LAUCKS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:717-848-2067
Mailing Address - Street 1:1601 SOUTH QUEEN STREET
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403
Mailing Address - Country:US
Mailing Address - Phone:717-848-2067
Mailing Address - Fax:717-848-2074
Practice Address - Street 1:1601 SOUTH QUEEN STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-848-2067
Practice Address - Fax:717-848-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02578700OtherBLUE CROSS
PA602560OtherBLUE SHIELD
PA122931Medicare PIN