Healthcare Provider Details

I. General information

NPI: 1770599136
Provider Name (Legal Business Name): RADIANCE-A PRIVATE OUTPATIENT SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BOYCE RD
BRIDGEVILLE PA
15017-1225
US

IV. Provider business mailing address

701 BOYCE RD
BRIDGEVILLE PA
15017-1225
US

V. Phone/Fax

Practice location:
  • Phone: 412-220-2336
  • Fax: 412-220-2279
Mailing address:
  • Phone: 412-220-2336
  • Fax: 412-220-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1760
License Number StatePA

VIII. Authorized Official

Name: SUDHIR RAO
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 412-220-2336