MEDICARE: SURGICAL 1ST ASSISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	SA0090	DC

General Provider Information

NPI Number	:	1104290162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL 1ST ASSISTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 7603
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-7603
Country	:	US
Telephone Number	:	602-315-5125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 W CARLA VISTA DR
Second Line	:	#7603
City	:	CHANDLER
State	:	AZ
Zip	:	85246-4001
Country	:	US
Telephone Number	:	602-315-5125
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DENNIS WHITE
Credential	:	M.D.
Telephone Number	:	602-315-5125

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/13/2015

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