=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376589895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY SURGICAL ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 DUDLEY ST STE 470
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-3248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-272-1800
-----------------------------------------------------
Fax | 401-751-5124
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 16149
-----------------------------------------------------
City | RUMFORD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02916-0697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-453-9625
-----------------------------------------------------
Fax | 401-435-7069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR DIRECTOR, REVENUE CYCLE
-----------------------------------------------------
Name | DONNA GORDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-443-4983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------