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General NPI Number Information
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NPI Number | 1619322781
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Entity Type | Organization
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Legal Business Name | AM SURGICAL ASSIST
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 273 HOLLYWOOD DR
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City | METAIRIE
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State | LA
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Zip | 70005-3919
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Country | US
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Telephone | 504-905-7456
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Fax |
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Provider Business Mailing Address
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Address Line | 273 HOLLYWOOD DR
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City | METAIRIE
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State | LA
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Zip | 70005-3919
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Country | US
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Telephone | 504-905-7456
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT
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Name | AMY MAUTNER
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Credential | CSFA
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Telephone | 504-905-7456
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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 |
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License Number State |
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