Provider Demographics
NPI:1962646471
Name:NORTHWOOD SURGICAL GROUP
Entity Type:Organization
Organization Name:NORTHWOOD SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-797-0500
Mailing Address - Street 1:3001 EASTLAND BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4104
Mailing Address - Country:US
Mailing Address - Phone:727-797-0500
Mailing Address - Fax:727-797-0050
Practice Address - Street 1:3001 EASTLAND BLVD
Practice Address - Street 2:STE 3
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-797-0500
Practice Address - Fax:727-797-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty