Healthcare Provider Details

I. General information

NPI: 1548223654
Provider Name (Legal Business Name): SPARTAN HEALTH SURGICENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STOOPS DRIVE GROUND FLOOR
MONONGAHELA PA
15063
US

IV. Provider business mailing address

100 STOOPS DRIVE GROUND FLOOR
MONONGAHELA PA
15063
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-2760
  • Fax: 724-483-2762
Mailing address:
  • Phone: 724-483-2760
  • Fax: 724-483-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1552
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1014402660001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. PATRICK GARMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 724-483-2760