MEDICARE: ALPHA SURGICAL ASSIST, 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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1487799144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA SURGICAL ASSIST, LLC

Provider Business Mailing Address
First Line	:	PO BOX 64087
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85728-4087
Country	:	US
Telephone Number	:	520-861-0481
Fax Number	:	520-696-1718

Provider Business Practice Location Address
First Line	:	4015 N FREMONT AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1065
Country	:	US
Telephone Number	:	520-861-0481
Fax Number	:	520-696-1718

Authorized Official
Title or Position	:	CERTIFIED FIRST ASSISTANT
Name	:	MR. ROBERT G. BUSH
Credential	:	CFA
Telephone Number	:	520-861-0481

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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