Provider Demographics
NPI:1841760717
Name:SURGICAL UNION, LLC
Entity Type:Organization
Organization Name:SURGICAL UNION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAMS NPI ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2800
Mailing Address - Street 1:1060 E COUNTY LINE RD STE 3A # 336
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1937
Mailing Address - Country:US
Mailing Address - Phone:601-282-9595
Mailing Address - Fax:
Practice Address - Street 1:1060 E COUNTY LINE RD STE 3A # 336
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1937
Practice Address - Country:US
Practice Address - Phone:601-282-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty