MEDICARE: IRON MAIDEN SURGICAL ASSISTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1336804863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRON MAIDEN SURGICAL ASSISTING LLC

Provider Business Mailing Address
First Line	:	4999 DREAM DANCER DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-0851
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	4999 DREAM DANCER DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-0851
Country	:	US
Telephone Number	:	505-639-3010
Fax Number	:

Authorized Official
Title or Position	:	SURGICAL ASSISTANT
Name	:	ROSEMARY GAISEY
Credential	:	CSFA
Telephone Number	:	505-639-3010

Provider Enumeration Date	:	10/31/2021
Last Update Date	:	05/03/2025

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