Provider Demographics
NPI:1649216573
Name:SURGICAL ASSOCIATES OF ZANESVILLE, INC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF ZANESVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-453-9616
Mailing Address - Street 1:2916 VANGADER DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1744
Mailing Address - Country:US
Mailing Address - Phone:740-453-9616
Mailing Address - Fax:740-453-4940
Practice Address - Street 1:2916 VANGADER DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1744
Practice Address - Country:US
Practice Address - Phone:740-453-9616
Practice Address - Fax:740-453-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH381886Medicaid
OHSU9287771Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER