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General NPI Number Information
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NPI Number | 1447506514
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Entity Type | Organization
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Legal Business Name | SURGICAL FIRST ASSIST, LLC
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 8921 BLACK PANTHER COVE
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City | HERENANDO
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State | MS
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Zip | 38632
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Country | US
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Telephone | 901-590-5968
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Fax |
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Provider Business Mailing Address
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Address Line | 8921 BLACK PANTHER COVE
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City | HERENANDO
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State | MS
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Zip | 38632
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Country | US
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Telephone | 901-590-5968
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Fax |
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Authorized Official
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Title or Position | CERTIFIED SURGICAL ASSISTANT / OWNE
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Name | MR. WILLIAM CLARK
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Credential | CSA
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Telephone | 901-590-5968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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