Healthcare Provider Details

I. General information

NPI: 1669420048
Provider Name (Legal Business Name): SURGICAL ASSIST,L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3913 MORTON DR
RICHMOND VA
23223-1287
US

IV. Provider business mailing address

PO BOX 1041
MECHANICSVILLE VA
23111-1041
US

V. Phone/Fax

Practice location:
  • Phone: 804-239-8208
  • Fax: 804-249-9132
Mailing address:
  • Phone: 804-239-8208
  • Fax: 804-249-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3123
License Number StateVA

VIII. Authorized Official

Name: MR. HENRY J.R. JACOBS
Title or Position: PRESIDENT/CEO
Credential: C.S.A.
Phone: 804-239-8208