Provider Demographics
NPI:1992734677
Name:TRUESDALE SURGICAL ASSOCIATES INC
Entity type:Organization
Organization Name:TRUESDALE SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-676-3411
Mailing Address - Street 1:1030 PRESIDENT AVE
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-676-3411
Mailing Address - Fax:508-676-0932
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 3002
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-676-3411
Practice Address - Fax:508-676-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C201OtherHPHC
RI43137OtherBS
1709090OtherUHC
S014348OtherTRICARE
0008822OtherNHP
605004OtherTUFTS
MA9754156Medicaid
RITS05277Medicaid
0124523OtherAETNA
M14632OtherMASS BS
MACB5955OtherRAIL ROAD MEDICARE
RI709003895Medicare PIN
MAM14632Medicare PIN