Provider Demographics
NPI:1942313879
Name:PA SURGICAL INC
Entity Type:Organization
Organization Name:PA SURGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-889-1227
Mailing Address - Street 1:621 NW 53RD ST STE 330
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-8281
Mailing Address - Country:US
Mailing Address - Phone:800-488-0279
Mailing Address - Fax:866-902-8817
Practice Address - Street 1:621 NW 53RD ST STE 330
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-8281
Practice Address - Country:US
Practice Address - Phone:561-440-7612
Practice Address - Fax:866-902-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X, 363L00000X
FLPA9101963363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX1578OtherBCBS PROVIDER NUMBER
FLK4563Medicare PIN