Provider Demographics
NPI:1528153053
Name:SURGICAL ASSOCIATES OF EASTERN SHORE PC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF EASTERN SHORE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAVRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-990-9191
Mailing Address - Street 1:767 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-990-9191
Mailing Address - Fax:251-990-9189
Practice Address - Street 1:767 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-990-9191
Practice Address - Fax:251-990-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529702280Medicaid
AL529702280Medicaid