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General NPI Number Information
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NPI Number | 1821872748
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Entity Type | Organization
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Legal Business Name | CONSOLIDATED SURGICAL SERVICES LLC
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 43169 GATWICK SQ
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City | ASHBURN
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State | VA
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Zip | 20147-4432
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Country | US
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Telephone | 623-533-9733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4042
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City | BROADLANDS
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State | VA
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Zip | 20148-0003
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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 | OWNER
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Name | JON JUDY
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Credential | CSFA
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Telephone | 623-533-9733
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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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