Provider Demographics
NPI:1396737615
Name:SURGICAL GROUP OF GAINESVILLE PA
Entity type:Organization
Organization Name:SURGICAL GROUP OF GAINESVILLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PANAGIOTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SARANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-1201
Mailing Address - Street 1:1143 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4218
Mailing Address - Country:US
Mailing Address - Phone:352-331-1201
Mailing Address - Fax:352-331-5273
Practice Address - Street 1:1143 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4218
Practice Address - Country:US
Practice Address - Phone:352-331-1201
Practice Address - Fax:352-331-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253318901Medicaid
FL253318901Medicaid