Provider Demographics
NPI:1023198157
Name:PREMIER SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:PREMIER SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAVDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-571-1170
Mailing Address - Street 1:PO BOX 20127
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-0127
Mailing Address - Country:US
Mailing Address - Phone:919-571-1170
Mailing Address - Fax:919-783-7743
Practice Address - Street 1:3410 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7234
Practice Address - Country:US
Practice Address - Phone:919-571-1170
Practice Address - Fax:919-783-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty