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Organization

EVANSVILLE SURGICAL ASSOCIATES INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARK CRUMMLEY (CHIEF OPERATIONS OFFICER)
(812) 424-8231
Entity
Organization

Contact information

Practice address
520 MARY ST STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
(812) 435-8794
Mailing address
520 MARY ST STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
(812) 435-8794

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2086S0102X
Surgical Critical Care Physician
2086S0120X
Pediatric Surgery Physician
2086S0127X
Trauma Surgery Physician
2086S0129X
Vascular Surgery Physician
208C00000X
Colon & Rectal Surgery Physician
246ZC0007X
Surgical Assistant
335E00000X
Prosthetic/Orthotic Supplier
363AM0700X
Medical Physician Assistant
363AS0400X
Surgical Physician Assistant
363LA2100X
Acute Care Nurse Practitioner
363LF0000X
Family Nurse Practitioner
363LG0600X
Gerontology Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100241430A
IN
01
101081
BCBS - GROUP
01
196912-153
IN LICENSE
IN
01
7100164050
KY GROUP MEDICAID - NURSE PRACTITIONERS
KY
01
7100229330
KY GROUP MEDICAID -PHYSICIANS
KY
01
7100261010
KY GROUP MEDICAID - PHYSICIAN ASSISTANT
KY
Enumeration date
05/17/2006
Last updated
11/04/2025
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