1457403248 NPI number — PRIME SURGICAL ASSOCIATES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457403248 NPI number — PRIME SURGICAL ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME SURGICAL ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457403248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3180 N POINT PKWY
Provider Second Line Business Mailing Address:
BULIDING 200 STE 207
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-4248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-559-8725
Provider Business Mailing Address Fax Number:
770-559-8276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3180 NORTH POINT PARKWAY
Provider Second Line Business Practice Location Address:
BULIDING 200 STE 207
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-559-8725
Provider Business Practice Location Address Fax Number:
770-559-8276
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CSA OWNER
Authorized Official Telephone Number:
770-559-8725

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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