MEDICARE: SURGICAL ASSISTANT SERVICES INC.

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1376528554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ASSISTANT SERVICES INC.

Provider Business Mailing Address
First Line	:	1016 W POPLAR AVE
Second Line	:	SUITE 106, PMB 309
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2600
Country	:	US
Telephone Number	:	901-831-2500
Fax Number	:	901-853-3188

Provider Business Practice Location Address
First Line	:	5959 PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5200
Country	:	US
Telephone Number	:	901-831-2500
Fax Number	:	901-853-3188

Authorized Official
Title or Position	:	CERTIFIED SURGICAL FIRST ASSISTANT
Name	:	MR. MICHAEL STAFFORD
Credential	:	C.S.A.
Telephone Number	:	901-831-2500

Provider Enumeration Date	:	12/11/2005
Last Update Date	:	05/07/2008

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