Provider Demographics
NPI:1376787614
Name:CLEARWATER SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CLEARWATER SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:727-446-5681
Mailing Address - Street 1:1106 DRUID RD S
Mailing Address - Street 2:STE 301
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3846
Mailing Address - Country:US
Mailing Address - Phone:727-446-5681
Mailing Address - Fax:727-461-6258
Practice Address - Street 1:1106 DRUID RD S
Practice Address - Street 2:STE 301
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3846
Practice Address - Country:US
Practice Address - Phone:727-446-5681
Practice Address - Fax:727-461-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty