MEDICARE: CAPITAL SURGICAL SPECIALISTS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1730150558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL SURGICAL SPECIALISTS, PA

Provider Business Mailing Address
First Line	:	1501 N BICKETT BLVD
Second Line	:	SUITE A
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2178
Country	:	US
Telephone Number	:	919-496-1050
Fax Number	:	919-496-0191

Provider Business Practice Location Address
First Line	:	1501 N BICKETT BLVD
Second Line	:	SUITE A
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2178
Country	:	US
Telephone Number	:	919-496-1050
Fax Number	:	919-496-0191

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOLLIS TIDMORE
Credential	:	MD
Telephone Number	:	919-496-1050

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	04/29/2008

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