Provider Demographics
NPI:1083999742
Name:RELIABLE SURGICAL ASSISTANT INC.
Entity Type:Organization
Organization Name:RELIABLE SURGICAL ASSISTANT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTER SURGICAL ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANJEANETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RSA
Authorized Official - Phone:313-574-9404
Mailing Address - Street 1:10 GEORGE ST
Mailing Address - Street 2:UNIT - E
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3164
Mailing Address - Country:US
Mailing Address - Phone:313-574-9404
Mailing Address - Fax:
Practice Address - Street 1:10 GEORGE ST
Practice Address - Street 2:UNIT - E
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3164
Practice Address - Country:US
Practice Address - Phone:313-574-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIABLE SURGICAL ASSISTANT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty