Provider Demographics
NPI:1861578536
Name:SURGERY CLINIC OF PHILADELPHIA
Entity type:Organization
Organization Name:SURGERY CLINIC OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-663-1233
Mailing Address - Street 1:1003 HOLLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2180
Mailing Address - Country:US
Mailing Address - Phone:601-663-1234
Mailing Address - Fax:601-663-1236
Practice Address - Street 1:1003 HOLLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2180
Practice Address - Country:US
Practice Address - Phone:601-663-1234
Practice Address - Fax:601-663-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00258672OtherMEDICARE RAILROAD