Provider Demographics
NPI:1306979034
Name:SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-664-7401
Mailing Address - Street 1:330 N WABASH AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-664-7401
Mailing Address - Fax:765-664-7428
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2600
Practice Address - Country:US
Practice Address - Phone:765-664-7401
Practice Address - Fax:765-664-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027484208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND94754Medicare UPIN
IN269200AMedicare ID - Type Unspecified