Provider Demographics
NPI:1538119631
Name:ASSOCIATES IN SURGERY PA
Entity Type:Organization
Organization Name:ASSOCIATES IN SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-349-7090
Mailing Address - Street 1:PO BOX 1880
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-1880
Mailing Address - Country:US
Mailing Address - Phone:843-347-7291
Mailing Address - Fax:843-347-0139
Practice Address - Street 1:2361 CYPRESS CIR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8921
Practice Address - Country:US
Practice Address - Phone:843-347-7291
Practice Address - Fax:843-347-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC4964Medicaid
SCC61126Medicare UPIN
SCG26829Medicare UPIN
SCH77713Medicare UPIN
SC3002Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER
SCPC4964Medicaid