MEDICARE: CAROLINA SURGICAL CARE ASSOCIATES, P. A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	38982	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104825694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA SURGICAL CARE ASSOCIATES, P. A.

Provider Business Mailing Address
First Line	:	105 MEDICAL DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3361
Country	:	US
Telephone Number	:	252-335-4890
Fax Number	:	252-335-7836

Provider Business Practice Location Address
First Line	:	105 MEDICAL DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3361
Country	:	US
Telephone Number	:	252-335-4890
Fax Number	:	252-335-7836

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTONIO JOSE RUIZ
Credential	:	MD
Telephone Number	:	252-335-4890

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/23/2010

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