=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023198157
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER SURGICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 03/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3410 SIX FORKS RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-7234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-571-1170
-----------------------------------------------------
Fax | 919-783-7743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20127
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27619-0127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-571-1170
-----------------------------------------------------
Fax | 919-783-7743
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. UDAY S KAVDE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 919-571-1170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 117435
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------