Provider Demographics
NPI:1316959612
Name:SURGICAL ASSOCIATES OF SMYTH COUNTY, PC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF SMYTH COUNTY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-782-9113
Mailing Address - Street 1:1203 SNIDER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4221
Mailing Address - Country:US
Mailing Address - Phone:276-782-9113
Mailing Address - Fax:276-782-9833
Practice Address - Street 1:1203 SNIDER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4221
Practice Address - Country:US
Practice Address - Phone:276-782-9113
Practice Address - Fax:276-782-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049504208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7367899Medicaid
VA282451OtherANTHEM
VA020019591Medicare PIN
VAC04714Medicare PIN