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General NPI Number Information
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NPI Number | 1497717177
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF SOUTH BOSTON INC
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2206A WILBORN AVE
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City | SOUTH BOSTON
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State | VA
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Zip | 24592
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Country | US
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Telephone | 434-572-2744
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Fax | 434-572-2785
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Provider Business Mailing Address
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Address Line | 2206A WILBORN AVE
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City | SOUTH BOSTON
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State | VA
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Zip | 24592
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Country | US
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Telephone | 434-572-2744
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Fax | 434-572-2785
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LOIS V ANDERSON
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Credential |
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Telephone | 434-572-2744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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