Provider Demographics
NPI:1871764860
Name:THE FACIAL SURGERY CENTER, L.L.C.
Entity type:Organization
Organization Name:THE FACIAL SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL, MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HALUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-547-0999
Mailing Address - Street 1:6545 ROUTE 819 STE 100
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-2665
Mailing Address - Country:US
Mailing Address - Phone:724-547-0999
Mailing Address - Fax:724-547-5345
Practice Address - Street 1:6545 ROUTE 819 STE 100
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-2665
Practice Address - Country:US
Practice Address - Phone:724-547-0999
Practice Address - Fax:724-547-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0218561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA044331OtherHIGHMARK BLUE SHIELD