Provider Demographics
NPI:1871976522
Name:HALL SURGICAL ASSISTANCE, LLC
Entity type:Organization
Organization Name:HALL SURGICAL ASSISTANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:MONZELLROE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:SA-C
Authorized Official - Phone:703-798-5924
Mailing Address - Street 1:PO BOX 15607
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22215-0607
Mailing Address - Country:US
Mailing Address - Phone:571-309-9768
Mailing Address - Fax:888-356-1032
Practice Address - Street 1:10332 MAIN ST
Practice Address - Street 2:SUITE #344
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2410
Practice Address - Country:US
Practice Address - Phone:703-798-5924
Practice Address - Fax:301-782-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty