Provider Demographics
NPI:1831463850
Name:ELITE SURGIAL, LLC
Entity Type:Organization
Organization Name:ELITE SURGIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:864-978-9636
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:LA FRANCE
Mailing Address - State:SC
Mailing Address - Zip Code:29656-0301
Mailing Address - Country:US
Mailing Address - Phone:864-978-9636
Mailing Address - Fax:
Practice Address - Street 1:21 CIRCLE STREET
Practice Address - Street 2:
Practice Address - City:LA FRANCE
Practice Address - State:SC
Practice Address - Zip Code:29656-0301
Practice Address - Country:US
Practice Address - Phone:864-978-9636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
92776246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty