Organization
MID CAROLINA SURGICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A GORDON M.D. (PRESIDENT)
(919) 775-3321
Entity
Organization
Contact information
Practice address
709B WICKER ST, SANFORD, NC 27330-4142
(919) 775-3321
(919) 774-6974
Mailing address
709B WICKER ST, SANFORD, NC 27330-4142
(919) 775-3321
(919) 774-6974
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13991
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170C
BCBS
—
01
—
36308
BCBS
—
05
—
8936308
—
NC
Enumeration date
05/11/2007
Last updated
06/19/2008
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