Provider Demographics
NPI:1083667364
Name:UNIFOUR SURGICAL ASSOICATES, PA
Entity Type:Organization
Organization Name:UNIFOUR SURGICAL ASSOICATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-267-6225
Mailing Address - Street 1:1771 TATE BLVD SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4250
Mailing Address - Country:US
Mailing Address - Phone:828-322-9105
Mailing Address - Fax:828-328-4999
Practice Address - Street 1:1771 TATE BLVD SE
Practice Address - Street 2:SUITE 101
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4250
Practice Address - Country:US
Practice Address - Phone:828-322-9105
Practice Address - Fax:828-328-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0239GOtherBCBS-NC
NC890239GMedicaid
NCCF8848OtherRAILROAD MEDICARE
NC890239GMedicaid