Provider Demographics
NPI:1467753863
Name:COMPLETE SURGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:COMPLETE SURGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIDICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-528-0447
Mailing Address - Street 1:261 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5317
Mailing Address - Country:US
Mailing Address - Phone:305-528-0447
Mailing Address - Fax:305-463-6693
Practice Address - Street 1:261 W 32ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5317
Practice Address - Country:US
Practice Address - Phone:305-528-0447
Practice Address - Fax:305-463-6693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104530363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY00XDOtherBC BS FL
FLDO667ZMedicare PIN