Basic Information
| Provider Information | |||||||||
| NPI: | 1467753863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPLETE SURGICAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 261 W 32ND ST | ||||||||
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| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330125317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055280447 | ||||||||
| FaxNumber: | 3054636693 | ||||||||
| Practice Location | |||||||||
| Address1: | 261 W 32ND ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330125317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055280447 | ||||||||
| FaxNumber: | 3054636693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2010 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | LIDICE | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3055280447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA 9104530 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | Y00XD | 01 | FL | BC BS FL | OTHER |