Provider Demographics
NPI:1881704237
Name:WATERFRONT SURGERY CENTER LLC
Entity type:Organization
Organization Name:WATERFRONT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-325-0775
Mailing Address - Street 1:495 WATERFRONT DR E
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1140
Mailing Address - Country:US
Mailing Address - Phone:412-325-2174
Mailing Address - Fax:412-325-2182
Practice Address - Street 1:495 WATERFRONT DR E
Practice Address - Street 2:SUITE 110
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1140
Practice Address - Country:US
Practice Address - Phone:412-325-2174
Practice Address - Fax:412-325-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16601501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1845OtherHIGHMARK BLUE CROSS BLUE
PA1845OtherHIGHMARK BLUE CROSS BLUE
PA391138Medicare ID - Type Unspecified