Basic Information
| Provider Information | |||||||||
| NPI: | 1407326291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TINSLEY SURGICAL, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 SHIPYARD BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284038019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107692583 | ||||||||
| FaxNumber: | 9107693531 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 SHIPYARD BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284038019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103996427 | ||||||||
| FaxNumber: | 9107693531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2018 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | TINSLEY | ||||||||
| AuthorizedOfficialFirstName: | ELLIS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9107692583 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.