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COLON & RECTAL SURGERY, LTD.
>> Colon & Rectal Surgery >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1659390698
Organizational Registrant:Organization Name: COLON & RECTAL SURGERY, LTD.
Organization is not Subpart
Authorized Official: KENNETH J BOYD PRESIDENT 610--56-53435
Organization is not Subpart
Authorized Official: KENNETH J BOYD PRESIDENT 610--56-53435
Location and contact information for practice:
1088 W BALTIMORE PIKE SUITE 2101 MEDIA, PA 19063-5136 US
Tel: 610-565-3435 Fax: 610-566-1387
Tel: 610-565-3435 Fax: 610-566-1387
Contact information for business:
1088 W BALTIMORE PIKE SUITE 2101 MEDIA, PA 19063-5136 US
Tel: 610-565-3435 Fax: 610-566-1387
Tel: 610-565-3435 Fax: 610-566-1387
Registration Information:
NPI: 1659390698
Entity Type: Organization
Entity Type: Organization
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 208C00000X | Allopathic & Osteopathic Physicians Colon & Rectal Surgery |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| INDEPENDENCE BLUE CROSS | 0091202000 | PA | 01 |
| PALMETTO GBA | CF6297 | GA | 01 |
| HIGHMARK BLUE SHIELD | 190824 | PA | 01 |
| KEYSTONE MERCY HEALTH PLA | 32129 | PA | 01 |
| 0009855080003 | PA | 05 |
