Provider Demographics
NPI:1508997883
Name:CAROLINA SURGICAL ARTS PA
Entity Type:Organization
Organization Name:CAROLINA SURGICAL ARTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:OWSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-288-0677
Mailing Address - Street 1:2516 OAKCREST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1932
Mailing Address - Country:US
Mailing Address - Phone:336-288-0677
Mailing Address - Fax:336-288-0784
Practice Address - Street 1:2516 OAKCREST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1932
Practice Address - Country:US
Practice Address - Phone:336-288-0677
Practice Address - Fax:336-288-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC348011223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0180TOtherBLUE CROSS BLUE SHIELD
NC59-13002OtherNC MEDICAID DENTAL
NC89-0180TMedicaid
F35871Medicare UPIN
NC59-13002OtherNC MEDICAID DENTAL