Healthcare Provider Details

I. General information

NPI: 1588182893
Provider Name (Legal Business Name): NEXGEN SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHERRY ST
BLUEFIELD WV
24701-3306
US

IV. Provider business mailing address

1765 E NINE MILE RD STE 1-229
PENSACOLA FL
32514-5479
US

V. Phone/Fax

Practice location:
  • Phone: 954-570-0337
  • Fax:
Mailing address:
  • Phone: 410-429-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KURT ZUMWALT
Title or Position: PRESIDENT CEO
Credential:
Phone: 410-404-6815