Provider Demographics
NPI:1013341171
Name:SURGICAL SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:SURGICAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRESCOTT
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:PRILLAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-683-5849
Mailing Address - Street 1:P.O BOX 99
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23146
Mailing Address - Country:US
Mailing Address - Phone:804-749-4249
Mailing Address - Fax:
Practice Address - Street 1:12439 WALNUT HILL DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:VA
Practice Address - Zip Code:23146
Practice Address - Country:US
Practice Address - Phone:804-749-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty