Provider Demographics
NPI:1174521959
Name:UNITED SURGICAL ASSOCIATES, P.C
Entity type:Organization
Organization Name:UNITED SURGICAL ASSOCIATES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:WROBLESKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:570-281-9000
Mailing Address - Street 1:75 N SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1833
Mailing Address - Country:US
Mailing Address - Phone:570-281-9000
Mailing Address - Fax:570-281-9200
Practice Address - Street 1:75 N SCOTT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1833
Practice Address - Country:US
Practice Address - Phone:570-281-9000
Practice Address - Fax:570-281-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009172L208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
202975OtherBLACK LUNG
814383OtherFIRST PRIORITY HEALTH
119234OtherTHREE RIVERS
1989020OtherFIRST HEALTH
3Y2164OtherHEALTHNET
PA925496OtherBLUE SHIELD INDIVIUAL
PA0077428240002Medicaid
PA2587081OtherAETNA
343958OtherHEALTHAMERICA
PA0001364500OtherBLUE SHIELD GROUP
66699OtherGEISINGER
P2741545OtherOXFORD
PA0001364500OtherBLUE SHIELD GROUP
343958OtherHEALTHAMERICA
=========OtherDEVON
119234OtherTHREE RIVERS
CJ8085Medicare PIN
=========OtherANTHEM