Provider Demographics
NPI:1851546758
Name:GOLDSBORO SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:GOLDSBORO SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-527-7400
Mailing Address - Street 1:619 OLD SYMSONIA ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5042
Mailing Address - Country:US
Mailing Address - Phone:270-527-7400
Mailing Address - Fax:270-527-2211
Practice Address - Street 1:619 OLD SYMSONIA ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5042
Practice Address - Country:US
Practice Address - Phone:270-527-7400
Practice Address - Fax:270-527-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000604915OtherANTHEM
KY00925Medicare PIN