Provider Demographics
NPI:1447506514
Name:SURGICAL FIRST ASSIST, LLC
Entity type:Organization
Organization Name:SURGICAL FIRST ASSIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL ASSISTANT / OWNE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:901-590-5968
Mailing Address - Street 1:8921 BLACK PANTHER COVE
Mailing Address - Street 2:
Mailing Address - City:HERENANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632
Mailing Address - Country:US
Mailing Address - Phone:901-590-5968
Mailing Address - Fax:
Practice Address - Street 1:8921 BLACK PANTHER COVE
Practice Address - Street 2:
Practice Address - City:HERENANDO
Practice Address - State:MS
Practice Address - Zip Code:38632
Practice Address - Country:US
Practice Address - Phone:901-590-5968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487886834OtherINDVIDUAL NPI BEFORE LLC FORMATION