Organization
PA SURGICAL INC
Active
Organization
PA SURGICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY T BOURG (CEO)
(561) 889-1227
Entity
Organization
Contact information
Practice address
621 NW 53RD ST STE 330, BOCA RATON, FL 33487-8281
(561) 440-7612
(866) 902-8817
Mailing address
621 NW 53RD ST STE 330, BOCA RATON, FL 33487-8281
(800) 488-0279
(866) 902-8817
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X1578
BCBS PROVIDER NUMBER
FL
Enumeration date
08/16/2006
Last updated
09/22/2020
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