Healthcare Provider Details

I. General information

NPI: 1780789628
Provider Name (Legal Business Name): SANFORD SURGICAL SPECIALTIES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 DOCTORS DR
SANFORD NC
27330-5057
US

IV. Provider business mailing address

1816 DOCTORS DR
SANFORD NC
27330-5057
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-7146
  • Fax: 919-774-7922
Mailing address:
  • Phone: 919-775-7146
  • Fax: 919-774-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number117811
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number117811
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number117811
License Number StateNC

VIII. Authorized Official

Name: MS. LAURA L FARMER
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-775-7146