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General NPI Number Information
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NPI Number | 1770599136
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Entity Type | Organization
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Legal Business Name | RADIANCE-A PRIVATE OUTPATIENT SURGERY CENTER LLC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 701 BOYCE RD
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-1225
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Country | US
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Telephone | 412-220-2336
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Fax | 412-220-2279
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Provider Business Mailing Address
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Address Line | 701 BOYCE RD
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-1225
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Country | US
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Telephone | 412-220-2336
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Fax | 412-220-2279
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SUDHIR RAO
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Credential | MD
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Telephone | 412-220-2336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1760
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License Number State | PA
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