=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598435760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGIKAL ASSISTANTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2021
-----------------------------------------------------
Last Update Date | 09/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19015 S JODI RD STE H
-----------------------------------------------------
City | MOKENA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60448-8534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-768-9521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19015 S JODI RD STE H
-----------------------------------------------------
City | MOKENA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60448-8534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-768-9521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | EMMA C ARAGON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-768-9521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------