Provider Demographics
NPI:1942535182
Name:SURFASTAT INC
Entity Type:Organization
Organization Name:SURFASTAT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:618-343-9150
Mailing Address - Street 1:907 N BLUFF RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-5816
Mailing Address - Country:US
Mailing Address - Phone:618-343-9150
Mailing Address - Fax:618-343-9155
Practice Address - Street 1:907 N BLUFF RD
Practice Address - Street 2:SUITE 4
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-5816
Practice Address - Country:US
Practice Address - Phone:618-343-9150
Practice Address - Fax:618-343-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies