Provider Demographics
NPI:1952375057
Name:OCONEE SURGERY, P.A.
Entity Type:Organization
Organization Name:OCONEE SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCEOLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:864-885-0608
Mailing Address - Street 1:112 SURGICAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6654
Mailing Address - Country:US
Mailing Address - Phone:864-885-0608
Mailing Address - Fax:864-885-0676
Practice Address - Street 1:112 SURGICAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6654
Practice Address - Country:US
Practice Address - Phone:864-885-0608
Practice Address - Fax:864-885-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC354027Medicaid
SC354027Medicaid
SC3089Medicare ID - Type Unspecified