Provider Demographics
NPI:1841619954
Name:SOUTH SHORE SURGICAL LLC
Entity type:Organization
Organization Name:SOUTH SHORE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-922-0222
Mailing Address - Street 1:10110 DONALD POWERS DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4057
Mailing Address - Country:US
Mailing Address - Phone:219-922-0222
Mailing Address - Fax:219-922-8899
Practice Address - Street 1:10110 DONALD POWERS DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4057
Practice Address - Country:US
Practice Address - Phone:219-922-0222
Practice Address - Fax:219-922-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty