Provider Demographics
NPI:1770773723
Name:SURGICAL SPECIALISTS, INC
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-291-6224
Mailing Address - Street 1:3444 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2525
Mailing Address - Country:US
Mailing Address - Phone:314-291-6224
Mailing Address - Fax:314-291-7346
Practice Address - Street 1:3444 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2525
Practice Address - Country:US
Practice Address - Phone:314-291-6224
Practice Address - Fax:314-291-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR6165208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD41518Medicare UPIN