Provider Demographics
NPI:1043204688
Name:INDIANA AMBULATORY SURGICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:INDIANA AMBULATORY SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BORBONUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-465-1922
Mailing Address - Street 1:841 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3620
Mailing Address - Country:US
Mailing Address - Phone:724-465-1922
Mailing Address - Fax:724-465-2636
Practice Address - Street 1:841 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3620
Practice Address - Country:US
Practice Address - Phone:724-465-1922
Practice Address - Fax:724-465-2636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-09
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10561500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017211930002Medicaid
PA0017211930002Medicaid