| Organization Name: | SURGICAL MEDICAL CLINIC |
| NPI Number: | 1417378779 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NASEEM H NASRALLAH (OWNER) |
| Mailing Address: | 407 East Fremont Street Burgaw |
| State: | NC US |
| Postal Code: | 284250729 |
| Phone Number: | 9102592161 |
| Fax Number: | 9102597870 |
| NPI Enumeration Date: | 01/03/2014 |
| NPI Last Update Date: | 01/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 5005024 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |