Healthcare Provider Details

I. General information

NPI: 1003851742
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF HAZLETON, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTH & WELLNESS CENTER 50 MOISEY DRIVE SUITE 214
HAZLETON PA
18202
US

IV. Provider business mailing address

HEALTH & WELLNESS CENTER 50 MOISEY DRIVE SUITE 214
HAZLETON PA
18202
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-6900
  • Fax: 570-501-6945
Mailing address:
  • Phone: 570-501-6900
  • Fax: 570-501-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0016137400005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. HAMEED AHMAD BUTT
Title or Position: CORPORATION PRESIDENT
Credential: MD
Phone: 570-501-6900