Provider Demographics
NPI:1851572531
Name:ANDREW H. RUZICH MD, PC
Entity type:Organization
Organization Name:ANDREW H. RUZICH MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-695-3371
Mailing Address - Street 1:236 W ALLEGHENY RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-9775
Mailing Address - Country:US
Mailing Address - Phone:724-695-3371
Mailing Address - Fax:724-695-3372
Practice Address - Street 1:236 W ALLEGHENY RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-9775
Practice Address - Country:US
Practice Address - Phone:724-695-3371
Practice Address - Fax:724-695-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058699L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013046300001Medicaid
PA001695766OtherHIGHMARK
PA1544528OtherGATEWAY
PAG27815Medicare UPIN
PA001695766OtherHIGHMARK