1467448951 NPI number — ROME SURGICAL GROUP LLC

Table of content: (NPI 1467448951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467448951 NPI number — ROME SURGICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROME SURGICAL GROUP LLC
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:
1467448951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13057-4503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-446-3904
Provider Business Mailing Address Fax Number:
315-445-2936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 TURIN RD
Provider Second Line Business Practice Location Address:
BLDG 2 SUITE 3
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-337-0202
Provider Business Practice Location Address Fax Number:
315-337-8188
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BULAWA
Authorized Official First Name:
BETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
315-337-0202

Provider Taxonomy Codes

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

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

  • Identifier: 01976787 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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