Provider Demographics
NPI:1235168337
Name:SURGICAL SPECIALISTS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-348-3700
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-348-3700
Mailing Address - Fax:805-348-3730
Practice Address - Street 1:316 S STRATFORD AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5908
Practice Address - Country:US
Practice Address - Phone:805-348-3700
Practice Address - Fax:805-348-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64528208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16527Medicare ID - Type UnspecifiedMEDICARE GRP ID
CAW16527Medicare PIN