Provider Demographics
NPI:1972761138
Name:WILD SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:WILD SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILD
Authorized Official - Suffix:
Authorized Official - Credentials:RN CRNFA
Authorized Official - Phone:609-350-2211
Mailing Address - Street 1:321 ENGLISH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:NJ
Mailing Address - Zip Code:08241-9794
Mailing Address - Country:US
Mailing Address - Phone:609-652-1276
Mailing Address - Fax:609-652-7498
Practice Address - Street 1:321 ENGLISH CREEK RD
Practice Address - Street 2:
Practice Address - City:PORT REPUBLIC
Practice Address - State:NJ
Practice Address - Zip Code:08241-9794
Practice Address - Country:US
Practice Address - Phone:609-652-1276
Practice Address - Fax:609-652-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital