Provider Demographics
NPI:1144373648
Name:PRINCETON SURGERY CENTER, LLC
Entity type:Organization
Organization Name:PRINCETON SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGIH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SATAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-385-1111
Mailing Address - Street 1:2020 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1045
Mailing Address - Country:US
Mailing Address - Phone:812-385-1111
Mailing Address - Fax:812-385-5022
Practice Address - Street 1:2030 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1045
Practice Address - Country:US
Practice Address - Phone:812-385-1111
Practice Address - Fax:812-385-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07-004101-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00212519OtherRAILROAD MEDICARE PIN
IN200809410AMedicaid
INZR6060Medicare PIN