Provider Demographics
NPI:1700068210
Name:ROCKY MOUNT SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ROCKY MOUNT SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-442-9600
Mailing Address - Street 1:1041 NOELL LN STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2055
Mailing Address - Country:US
Mailing Address - Phone:252-442-9600
Mailing Address - Fax:252-442-9611
Practice Address - Street 1:1041 NOELL LN STE 105
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2055
Practice Address - Country:US
Practice Address - Phone:252-442-9600
Practice Address - Fax:252-442-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC115557208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133THMedicaid
NC89133THMedicaid
NC2342166Medicare PIN