Provider Demographics
NPI:1891759437
Name:VILLAGE SURGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:VILLAGE SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-323-2626
Mailing Address - Street 1:PO BOX 64367
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-0367
Mailing Address - Country:US
Mailing Address - Phone:910-323-2626
Mailing Address - Fax:910-483-6376
Practice Address - Street 1:1841 QUIET CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3857
Practice Address - Country:US
Practice Address - Phone:910-323-2626
Practice Address - Fax:910-483-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX IDENTIFICATION NUMBER