Healthcare Provider Details

I. General information

NPI: 1972818730
Provider Name (Legal Business Name): ELITE SURGICAL ASSISTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10402 BAYPORT RD
LOUISVILLE KY
40299-4078
US

IV. Provider business mailing address

10402 BAYPORT RD
LOUISVILLE KY
40299-4078
US

V. Phone/Fax

Practice location:
  • Phone: 502-267-6947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARSHA E NELSON
Title or Position: CEO
Credential:
Phone: 502-267-6947