Provider Demographics
NPI:1568761690
Name:GI SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:GI SURGERY ASSOCIATES
Other - Org Name:CAROLINA HOSPITAL AUTHORITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:704-582-1820
Mailing Address - Street 1:204 POMPANO DR SE
Mailing Address - Street 2:18TH MDG MEDICAL GROUP
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-6403
Mailing Address - Country:US
Mailing Address - Phone:704-582-1820
Mailing Address - Fax:704-919-5000
Practice Address - Street 1:204 POMPANO DRIVE S.E.
Practice Address - Street 2:18TH MEDICAL GROUP
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705
Practice Address - Country:US
Practice Address - Phone:704-582-1820
Practice Address - Fax:704-919-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15731M2865X1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)