Provider Demographics
NPI:1831149111
Name:WOLF CREEK SURGEONS, P.A.
Entity type:Organization
Organization Name:WOLF CREEK SURGEONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PLASKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-674-2420
Mailing Address - Street 1:103 WOLF CREEK BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4915
Mailing Address - Country:US
Mailing Address - Phone:302-674-2420
Mailing Address - Fax:302-674-4473
Practice Address - Street 1:103 WOLF CREEK BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4915
Practice Address - Country:US
Practice Address - Phone:302-674-2420
Practice Address - Fax:302-674-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00659Medicare UPIN