Provider Demographics
NPI:1801960018
Name:STAT SURGICAL ASSOC INC
Entity type:Organization
Organization Name:STAT SURGICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:COLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-266-6343
Mailing Address - Street 1:1483 TOBIAS GADSON BLVD
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-266-6343
Mailing Address - Fax:843-266-6353
Practice Address - Street 1:1483 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 202B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-266-6343
Practice Address - Fax:843-266-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty