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General NPI Number Information
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NPI Number | 1053446708
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Entity Type | Organization
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Legal Business Name | EASTERN SURGICAL ASSISTANTS, LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 16427 METRO AVE
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City | BONNER SPRINGS
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State | KS
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Zip | 66012-7108
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Country | US
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Telephone | 240-602-3922
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 587
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City | BASEHOR
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State | KS
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Zip | 66007-0587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT - CERTIFIED
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Name | MR. ANDREW BURNETT
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Credential | SA-C
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Telephone | 240-602-3922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 06-265
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License Number State | MD
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