1952375057 NPI number — OCONEE SURGERY, P.A.

Table of content: (NPI 1952375057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952375057 NPI number — OCONEE SURGERY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCONEE SURGERY, P.A.
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:
1952375057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 SURGICAL BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SENECA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29672-6654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-885-0608
Provider Business Mailing Address Fax Number:
864-885-0676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 SURGICAL BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29672-6654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-885-0608
Provider Business Practice Location Address Fax Number:
864-885-0676
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
OSCEOLA
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
864-885-0608

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 354027 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com