Provider Demographics
NPI:1013336569
Name:FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI
Entity type:Organization
Organization Name:FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:720-639-4188
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80520-0184
Mailing Address - Country:US
Mailing Address - Phone:720-639-4188
Mailing Address - Fax:720-639-4188
Practice Address - Street 1:478 1ST ST STE 184
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80520-9900
Practice Address - Country:US
Practice Address - Phone:720-639-4188
Practice Address - Fax:720-639-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty