Provider Demographics
NPI:1639173388
Name:ROCK HILL SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:ROCK HILL SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-324-5256
Mailing Address - Street 1:PO BOX 36070
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0500
Mailing Address - Country:US
Mailing Address - Phone:803-324-5256
Mailing Address - Fax:803-328-0440
Practice Address - Street 1:1721 EBENEZER RD
Practice Address - Street 2:SUITE 175
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4103
Practice Address - Country:US
Practice Address - Phone:803-324-5256
Practice Address - Fax:803-328-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC250665365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA3601Medicaid
SCPA3601Medicaid
SC1290Medicare ID - Type Unspecified
NC2344391Medicare ID - Type Unspecified