Provider Demographics
NPI:1407499841
Name:AW SURGERY PA
Entity type:Organization
Organization Name:AW SURGERY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-500-3350
Mailing Address - Street 1:6274 LAKE OSPREY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8425
Mailing Address - Country:US
Mailing Address - Phone:941-500-3350
Mailing Address - Fax:941-220-4338
Practice Address - Street 1:6274 LAKE OSPREY DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8425
Practice Address - Country:US
Practice Address - Phone:941-500-3350
Practice Address - Fax:941-220-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty