Provider Demographics
NPI:1033481551
Name:METRO SURGICAL PC
Entity Type:Organization
Organization Name:METRO SURGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-826-4057
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-0919
Mailing Address - Country:US
Mailing Address - Phone:912-826-4057
Mailing Address - Fax:912-826-2853
Practice Address - Street 1:12 ARLEY WAY
Practice Address - Street 2:STE 103B
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8860
Practice Address - Country:US
Practice Address - Phone:912-826-4057
Practice Address - Fax:912-826-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043557174400000X
SCMD26551174400000X
208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00791557AMedicaid
GA055003099AMedicaid
GACN8505OtherRR CARE
SCGPA720Medicaid