=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295715258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURLINGTON SURGICAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2006
-----------------------------------------------------
Last Update Date | 02/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1236 HUFFMAN MILL RD 1500 MEDICAL ARTS CTR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-538-1900
-----------------------------------------------------
Fax | 336-538-1989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1236 HUFFMAN MILL RD 1500 MEDICAL ARTS CTR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-538-1900
-----------------------------------------------------
Fax | 336-538-1989
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. TERESA HADLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-538-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------