Healthcare Provider Details

I. General information

NPI: 1134353642
Provider Name (Legal Business Name): SOUTHERN SURGICAL ASSIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 LINWOOD AVE
METAIRIE LA
70003-2309
US

IV. Provider business mailing address

1113 LINWOOD AVE
METAIRIE LA
70003-2309
US

V. Phone/Fax

Practice location:
  • Phone: 504-460-9945
  • Fax: 504-264-7434
Mailing address:
  • Phone: 504-460-9945
  • Fax: 504-264-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number112468
License Number StateLA

VIII. Authorized Official

Name: MEGAN CATHERINE HINTZ
Title or Position: RNFA
Credential: RNFA
Phone: 504-460-9945