Provider Demographics
NPI:1427094945
Name:TRI-STATE SURGERY CENTER LLC
Entity type:Organization
Organization Name:TRI-STATE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-225-8800
Mailing Address - Street 1:80 LANDINGS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9408
Mailing Address - Country:US
Mailing Address - Phone:724-225-8800
Mailing Address - Fax:724-225-7909
Practice Address - Street 1:80 LANDINGS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9408
Practice Address - Country:US
Practice Address - Phone:724-225-8800
Practice Address - Fax:724-225-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23351501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100879105001Medicaid
PA075685OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)
PA084963TD6Medicare PIN