Provider Demographics
NPI:1205979481
Name:R.P.H. SURGICAL, INC.
Entity type:Organization
Organization Name:R.P.H. SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HENNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-553-4404
Mailing Address - Street 1:2076 NC HWY 42 W
Mailing Address - Street 2:STE 240 JOHNSTON PROFESSIONAL PLAZA
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-9226
Mailing Address - Country:US
Mailing Address - Phone:919-553-4404
Mailing Address - Fax:919-553-4150
Practice Address - Street 1:2076 NC HWY 42 W
Practice Address - Street 2:STE 240 JOHNSTON PROFESSIONAL PLAZA
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9226
Practice Address - Country:US
Practice Address - Phone:919-553-4404
Practice Address - Fax:919-553-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00052208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG30379Medicare UPIN