Provider Demographics
NPI:1689767758
Name:BEVERLY SURGICAL ASSOCIATES INC
Entity type:Organization
Organization Name:BEVERLY SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:KACOYANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-927-4004
Mailing Address - Street 1:75 HERRICK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-4004
Mailing Address - Fax:978-922-6640
Practice Address - Street 1:75 HERRICK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-4004
Practice Address - Fax:978-922-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9700609Medicaid
MA9700609Medicaid