MEDICARE: CAPITAL SURGICAL ASSOCIATES PA

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

General Provider Information

NPI Number	:	1407889066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL SURGICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	2800 BLUE RIDGE BLVD
Second Line	:	SUITE 201
City	:	RALEIGH
State	:	NC
Zip	:	27607-6477
Country	:	US
Telephone Number	:	919-420-5000
Fax Number	:	919-420-5006

Provider Business Practice Location Address
First Line	:	2800 BLUE RIDGE RD
Second Line	:	SUITE 201
City	:	RALEIGH
State	:	NC
Zip	:	27607-6478
Country	:	US
Telephone Number	:	919-420-5000
Fax Number	:	919-420-5006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM TUCKER CLINE
Credential	:	M.D.
Telephone Number	:	919-420-5000

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

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