Healthcare Provider Details

I. General information

NPI: 1942313879
Provider Name (Legal Business Name): PA SURGICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 NW 53RD ST STE 330
BOCA RATON FL
33487-8281
US

IV. Provider business mailing address

621 NW 53RD ST STE 330
BOCA RATON FL
33487-8281
US

V. Phone/Fax

Practice location:
  • Phone: 561-440-7612
  • Fax: 866-902-8817
Mailing address:
  • Phone: 800-488-0279
  • Fax: 866-902-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NANCY T BOURG
Title or Position: CEO
Credential:
Phone: 561-889-1227