Healthcare Provider Details

I. General information

NPI: 1427872548
Provider Name (Legal Business Name): RALEIGH EMERGENCY SURGICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 SKYLAND RIDGE PKWY STE 203
RALEIGH NC
27617-6813
US

IV. Provider business mailing address

1303 CANTERBURY RD
RALEIGH NC
27608-1901
US

V. Phone/Fax

Practice location:
  • Phone: 919-881-8295
  • Fax:
Mailing address:
  • Phone: 919-414-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HARRY KURTZ
Title or Position: EMPLOYEE
Credential: PA-C
Phone: 561-628-7115