Provider Demographics
NPI:1801884796
Name:MEADVILLE SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:MEADVILLE SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WEIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-337-6602
Mailing Address - Street 1:765 LIBERTY ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2566
Mailing Address - Country:US
Mailing Address - Phone:814-337-6602
Mailing Address - Fax:814-336-5307
Practice Address - Street 1:765 LIBERTY ST
Practice Address - Street 2:SUITE 311
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-337-6602
Practice Address - Fax:814-336-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054547L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01746521Medicaid
G91236Medicare UPIN
PA01746521Medicaid