Provider Demographics
NPI:1023647476
Name:SOUTHWEST SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:SOUTHWEST SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-577-4882
Mailing Address - Street 1:8229 RIVER COURSE DR
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-6912
Mailing Address - Country:US
Mailing Address - Phone:540-577-4882
Mailing Address - Fax:
Practice Address - Street 1:101 1ST ST NW STE 2
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5605
Practice Address - Country:US
Practice Address - Phone:540-577-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty