Provider Demographics
NPI:1114956919
Name:PREMIER SURGICAL SERVICES, PA
Entity Type:Organization
Organization Name:PREMIER SURGICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:864-227-8932
Mailing Address - Street 1:105 VINE CREST CT
Mailing Address - Street 2:STE 500
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-8031
Mailing Address - Country:US
Mailing Address - Phone:864-227-8932
Mailing Address - Fax:864-227-8973
Practice Address - Street 1:105 VINE CREST CT
Practice Address - Street 2:STE 500
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-227-8932
Practice Address - Fax:864-227-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3771Medicaid
SC=========OtherBCBS
SC=========OtherBCBS