Provider Demographics
NPI:1487758785
Name:ONSLOW SURGICAL CLINIC PA
Entity type:Organization
Organization Name:ONSLOW SURGICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:GIVENS
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-353-7848
Mailing Address - Street 1:255 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-353-7848
Mailing Address - Fax:910-353-5052
Practice Address - Street 1:255 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-353-7848
Practice Address - Fax:910-353-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902340Medicaid
NC230266Medicare ID - Type Unspecified