Provider Demographics
NPI:1801305073
Name:PANDUGA SURGICAL CARE, PLLC
Entity type:Organization
Organization Name:PANDUGA SURGICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAMS NPI ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2800
Mailing Address - Street 1:4904 S POWER RD STE 103
Mailing Address - Street 2:PMB 450
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3610
Mailing Address - Country:US
Mailing Address - Phone:602-734-1945
Mailing Address - Fax:
Practice Address - Street 1:4904 S POWER RD STE 103
Practice Address - Street 2:PMB 450
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3610
Practice Address - Country:US
Practice Address - Phone:602-734-1945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty