Provider Demographics
NPI:1184686180
Name:SURGICAL ASSOCIATES OF ASHEBORO, PLLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF ASHEBORO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:GIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-625-2456
Mailing Address - Street 1:171 MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5410
Mailing Address - Country:US
Mailing Address - Phone:336-625-2456
Mailing Address - Fax:336-625-1136
Practice Address - Street 1:171 MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5410
Practice Address - Country:US
Practice Address - Phone:336-625-2456
Practice Address - Fax:336-625-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012TWMedicaid
NC012TWOtherBC/BS
NC012TWOtherBC/BS