Organization
GREENVILLE SURGICAL ASSOC., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES J KOLENICH M.D. (PRESIDENT)
(724) 588-5600
Entity
Organization
Contact information
Practice address
111 N MAIN ST, GREENVILLE, PA 16125-1705
(724) 588-5600
Mailing address
111 N MAIN ST, GREENVILLE, PA 16125-1705
(724) 588-5600
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
407325
MEDICAR PROVIDER NUMBER
PA
Enumeration date
08/16/2007
Last updated
08/16/2007
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