Provider Demographics
NPI:1154387942
Name:FORT PITT SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:FORT PITT SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-364-5490
Mailing Address - Street 1:8199 MCKNIGHT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5749
Mailing Address - Country:US
Mailing Address - Phone:412-364-5490
Mailing Address - Fax:412-364-5493
Practice Address - Street 1:8199 MCKNIGHT RD STE 102
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5749
Practice Address - Country:US
Practice Address - Phone:412-364-5490
Practice Address - Fax:412-364-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042446L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1704724OtherHIGHMARK BS
1560653OtherGATEWAY
DD1842OtherRAILROAD MEDICARE
PA1012751800001Medicaid
PA090105Medicare PIN
=========OtherGREAT WEST
=========OtherTRICARE
=========OtherAETNA
DD1842OtherRAILROAD MEDICARE
=========OtherDEVON
PA090105Medicare PIN
=========OtherINTERGROUP
=========OtherUPMC
1560653OtherGATEWAY