Provider Demographics
NPI:1093046963
Name:PHYSICIAN ASSISTANT SURGICAL SPECIALISTS
Entity Type:Organization
Organization Name:PHYSICIAN ASSISTANT SURGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VAN VLEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-614-4178
Mailing Address - Street 1:8979 HAVILAND RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-0617
Mailing Address - Country:US
Mailing Address - Phone:702-614-4178
Mailing Address - Fax:702-614-4179
Practice Address - Street 1:8979 HAVILAND RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-0617
Practice Address - Country:US
Practice Address - Phone:702-614-4178
Practice Address - Fax:702-614-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty