Provider Demographics
NPI:1053470849
Name:SURG MED ASSISTANTS
Entity Type:Organization
Organization Name:SURG MED ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-586-0717
Mailing Address - Street 1:8102 NW 158TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7119
Mailing Address - Country:US
Mailing Address - Phone:305-558-2787
Mailing Address - Fax:305-819-9714
Practice Address - Street 1:8102 NW 158TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-7119
Practice Address - Country:US
Practice Address - Phone:305-586-0717
Practice Address - Fax:305-819-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0547Medicare ID - Type UnspecifiedMEDICARE GROUP