=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801855127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR THE SURGICAL ARTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2006
-----------------------------------------------------
Last Update Date | 03/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3107 FAIRWAY DRIVE
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-414-4848
-----------------------------------------------------
Fax | 814-201-2256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3107 FAIRWAY DRIVE
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-414-4848
-----------------------------------------------------
Fax | 814-201-2256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ERIC ALI AGHA RAAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-777-7702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 1843
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------