MEDICARE: ROCK HILL 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	208600000X	Surgery Physician	250665365	SC

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	:	1639173388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK HILL SURGICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 36070
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-0500
Country	:	US
Telephone Number	:	803-324-5256
Fax Number	:	803-328-0440

Provider Business Practice Location Address
First Line	:	1721 EBENEZER RD
Second Line	:	SUITE 175
City	:	ROCK HILL
State	:	SC
Zip	:	29732-4103
Country	:	US
Telephone Number	:	803-324-5256
Fax Number	:	803-328-0440

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	PAT FEDELE
Credential	:
Telephone Number	:	803-324-5256

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/05/2008

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