Provider Demographics
NPI:1104601251
Name:SRS MEDICAL LLC
Entity type:Organization
Organization Name:SRS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:847-340-0010
Mailing Address - Street 1:96 ELK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8730
Mailing Address - Country:US
Mailing Address - Phone:847-340-0010
Mailing Address - Fax:
Practice Address - Street 1:96 ELK GROVE LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-8730
Practice Address - Country:US
Practice Address - Phone:847-340-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty