Provider Demographics
NPI:1104882299
Name:CAPITAL AREA SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:CAPITAL AREA SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-232-4112
Mailing Address - Street 1:2626 N 3RD ST
Mailing Address - Street 2:THE ROSE GARDEN, SUITE 2B
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-2044
Mailing Address - Country:US
Mailing Address - Phone:717-232-4112
Mailing Address - Fax:717-233-8022
Practice Address - Street 1:2626 N 3RD ST
Practice Address - Street 2:THE ROSE GARDEN, SUITE 2B
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2044
Practice Address - Country:US
Practice Address - Phone:717-232-4112
Practice Address - Fax:717-233-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02277400OtherPA BLUE CROSS
PA469587OtherUS HEALTHCARE
PA02277400OtherKEYSTONE HEALTH PLAN
PACA427226Medicare ID - Type Unspecified