Provider Demographics
NPI:1033783576
Name:SURGICAL SUPPLY SOLUTIONS
Entity Type:Organization
Organization Name:SURGICAL SUPPLY SOLUTIONS
Other - Org Name:SURGICAL SUPPLY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CFA
Authorized Official - Phone:501-658-6186
Mailing Address - Street 1:2425 SANSONNET LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3597
Mailing Address - Country:US
Mailing Address - Phone:501-658-6186
Mailing Address - Fax:
Practice Address - Street 1:2425 SANSONNET LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3597
Practice Address - Country:US
Practice Address - Phone:501-658-6186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty