Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

IV. Provider business mailing address

105 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-4890
  • Fax: 252-335-7836
Mailing address:
  • Phone: 252-335-4890
  • Fax: 252-335-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number38982
License Number StateNC

VIII. Authorized Official

Name: DR. ANTONIO JOSE RUIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 252-335-4890