Provider Demographics
NPI:1427090208
Name:TRISTATE SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:TRISTATE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BELICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-728-8300
Mailing Address - Street 1:93 BOUNDRY LN
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2949
Mailing Address - Country:US
Mailing Address - Phone:724-728-8300
Mailing Address - Fax:724-728-6470
Practice Address - Street 1:93 BOUNDRY LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2949
Practice Address - Country:US
Practice Address - Phone:724-728-8300
Practice Address - Fax:724-728-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00002470Medicare ID - Type Unspecified