Provider Demographics
NPI:1063612034
Name:SURF CITY POOLS & SPAS
Entity type:Organization
Organization Name:SURF CITY POOLS & SPAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-949-3007
Mailing Address - Street 1:10505 MACCORKLE AVE
Mailing Address - Street 2:
Mailing Address - City:MARMET
Mailing Address - State:WV
Mailing Address - Zip Code:25315-1967
Mailing Address - Country:US
Mailing Address - Phone:304-949-3007
Mailing Address - Fax:304-949-3207
Practice Address - Street 1:10505 MACCORKLE AVE
Practice Address - Street 2:
Practice Address - City:MARMET
Practice Address - State:WV
Practice Address - Zip Code:25315-1967
Practice Address - Country:US
Practice Address - Phone:304-949-3007
Practice Address - Fax:304-949-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment