Provider Demographics
NPI:1578817474
Name:SOUTH ATLANTIC SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SOUTH ATLANTIC SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:240-997-4720
Mailing Address - Street 1:PO BOX 535698
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053-5698
Mailing Address - Country:US
Mailing Address - Phone:240-997-4720
Mailing Address - Fax:
Practice Address - Street 1:2709 HOSPITAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1017
Practice Address - Country:US
Practice Address - Phone:240-997-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3096207VX0000X
2084P0804X
TXN7387208600000X
TXN66052086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty