Basic Information
| Provider Information | |||||||||
| NPI: | 1639173388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCK HILL SURGICAL ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36070 | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297320500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033245256 | ||||||||
| FaxNumber: | 8033280440 | ||||||||
| Practice Location | |||||||||
| Address1: | 1721 EBENEZER RD | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297324103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033245256 | ||||||||
| FaxNumber: | 8033280440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | FEDELE | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8033245256 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 250665365 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | PA3601 | 05 | SC | MEDICAID |