Provider Demographics
NPI:1952408783
Name:SHADYSIDE SURGI-CENTER, INC.
Entity type:Organization
Organization Name:SHADYSIDE SURGI-CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:412-363-6626
Mailing Address - Street 1:5727 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3707
Mailing Address - Country:US
Mailing Address - Phone:412-363-6626
Mailing Address - Fax:412-363-7008
Practice Address - Street 1:5727 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3707
Practice Address - Country:US
Practice Address - Phone:412-363-6626
Practice Address - Fax:412-363-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001506187002Medicaid
PA0177OtherHIGHMARK ID
PA001506187002Medicaid