Provider Demographics
NPI:1114477072
Name:EMPAC SURGICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:EMPAC SURGICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:MR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANANSALA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-717-6779
Mailing Address - Street 1:271 E SPUR AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2239
Mailing Address - Country:US
Mailing Address - Phone:602-717-6779
Mailing Address - Fax:
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:480-256-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2356363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty