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General NPI Number Information
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NPI Number | 1912344607
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Entity Type | Organization
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Legal Business Name | KEYSTONE SURGICAL ASSISTANTS INC.
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 200 S RIVER ST
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City | PLAINS
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State | PA
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Zip | 18705-1143
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Country | US
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Telephone | 570-899-5605
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Fax | 570-821-1105
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Provider Business Mailing Address
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Address Line | 200 S RIVER ST
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City | PLAINS
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State | PA
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Zip | 18705-1143
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Country | US
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Telephone | 570-899-5605
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Fax | 570-821-1105
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Authorized Official
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Title or Position | CERTIFIED SURGICAL ASSISTANT
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Name | MR. CHARLES A. JOBST III
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Credential | CSA
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Telephone | 570-417-8831
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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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