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General NPI Number Information
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NPI Number | 1770761785
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Entity Type | Organization
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Legal Business Name | ABC SURGICAL, LLC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 1651B N MAIN ST
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City | BUTLER
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State | PA
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Zip | 16001-1512
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Country | US
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Telephone | 724-285-4965
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Fax | 724-282-3404
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Provider Business Mailing Address
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Address Line | 1651B N MAIN ST
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City | BUTLER
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State | PA
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Zip | 16001-1512
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Country | US
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Telephone | 724-285-4965
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Fax | 724-282-3404
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTINE EVANKOVICH-EDWARDS
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Credential | M.D.
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Telephone | 724-285-4965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 073241L
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License Number State | PA
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