Provider Demographics
NPI:1770599136
Name:RADIANCE-A PRIVATE OUTPATIENT SURGERY CENTER LLC
Entity type:Organization
Organization Name:RADIANCE-A PRIVATE OUTPATIENT SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-220-2336
Mailing Address - Street 1:701 BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1225
Mailing Address - Country:US
Mailing Address - Phone:412-220-2336
Mailing Address - Fax:412-220-2279
Practice Address - Street 1:701 BOYCE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1225
Practice Address - Country:US
Practice Address - Phone:412-220-2336
Practice Address - Fax:412-220-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1760261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA261596OtherHEALTH AMERICA
PA102775173 001Medicaid
PA0253OtherBLUE SHIELD BLUE CROSS
089284Medicare PIN