Healthcare Provider Details

I. General information

NPI: 1255302899
Provider Name (Legal Business Name): CENTRAL CAROLINA SURGICAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 CARTHAGE ST SUITE 110
SANFORD NC
27330-4111
US

IV. Provider business mailing address

1139 CARTHAGE ST SUITE 110
SANFORD NC
27330-4111
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-7232
  • Fax: 919-775-1731
Mailing address:
  • Phone: 919-775-7232
  • Fax: 919-775-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELIA FISH
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-775-7232