Basic Information
| Provider Information | |||||||||
| NPI: | 1689849457 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST SURGICAL ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1004 WELLS ST | ||||||||
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| City: | BENNETTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295122718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436157743 | ||||||||
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| Address1: | 1004 WELLS ST | ||||||||
| Address2: | |||||||||
| City: | BENNETTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295122718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436157743 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | CROSLAND | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 8436157743 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | SR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.