Provider Demographics
NPI:1801931399
Name:MED-SURG PAS INC
Entity type:Organization
Organization Name:MED-SURG PAS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:813-633-8489
Mailing Address - Street 1:5121 STATE ROAD 674
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-3515
Mailing Address - Country:US
Mailing Address - Phone:813-633-8489
Mailing Address - Fax:813-633-2669
Practice Address - Street 1:5121 STATE ROAD 674
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-3515
Practice Address - Country:US
Practice Address - Phone:813-633-8489
Practice Address - Fax:813-633-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660052201Medicaid
FL660052200Medicaid
FLH58385Medicare UPIN
FL103923Medicare Oscar/Certification