Healthcare Provider Details

I. General information

NPI: 1891759437
Provider Name (Legal Business Name): VILLAGE SURGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 QUIET CV
FAYETTEVILLE NC
28304-3857
US

IV. Provider business mailing address

PO BOX 64367
FAYETTEVILLE NC
28306-0367
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-2626
  • Fax: 910-483-6376
Mailing address:
  • Phone: 910-323-2626
  • Fax: 910-483-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JAMES A CLASSEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 910-323-2626