Provider Demographics
NPI:1679635734
Name:SURGICAL ASSOCIATES,M.D.,PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES,M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WONDER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:417-334-1093
Mailing Address - Street 1:547 BRANSON LANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-334-1093
Mailing Address - Fax:417-334-1064
Practice Address - Street 1:547 BRANSON LANDING BLVD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-334-1093
Practice Address - Fax:417-334-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1E13208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020007605Medicaid
MO2020007605Medicaid
MOA11937Medicare UPIN