Provider Demographics
NPI:1891955415
Name:SURGICAL GROUP A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SURGICAL GROUP A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:BYRNES
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-364-7226
Mailing Address - Street 1:602 N LEWIS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2093
Mailing Address - Country:US
Mailing Address - Phone:337-364-7226
Mailing Address - Fax:337-364-7238
Practice Address - Street 1:602 N LEWIS ST
Practice Address - Street 2:STE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2093
Practice Address - Country:US
Practice Address - Phone:337-364-7226
Practice Address - Fax:337-364-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1554821Medicaid
LA1554821Medicaid
LA5DE79Medicare PIN