Provider Demographics
NPI:1457663940
Name:SURGIPRO, INC.
Entity Type:Organization
Organization Name:SURGIPRO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TERRITORY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-858-8503
Mailing Address - Street 1:2576 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7290
Mailing Address - Country:US
Mailing Address - Phone:770-904-4215
Mailing Address - Fax:770-904-4216
Practice Address - Street 1:2576 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:BUILDING 1
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7290
Practice Address - Country:US
Practice Address - Phone:770-904-4215
Practice Address - Fax:770-904-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies