Provider Demographics
NPI:1902876212
Name:SCAC LLC
Entity Type:Organization
Organization Name:SCAC LLC
Other - Org Name:SURGERY CENTER AT CRANBERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-772-1766
Mailing Address - Street 1:105 BRANDT DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-772-1766
Mailing Address - Fax:724-772-5947
Practice Address - Street 1:105 BRANDT DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-772-1766
Practice Address - Fax:724-772-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16591501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7571524OtherAETNA PPO
7222631OtherCIGNA
PA2088OtherHIGHMARK BLUECROSS BS
3449654OtherAETNA HMO
PA100887180Medicaid
P00073763OtherRAILROAD MEDICARE
275001OtherHEALTH AMERICA
153357OtherMEDPLUS
7222631OtherCIGNA