Provider Demographics
NPI:1215213756
Name:NORTHWEST ASSOCIATION OF SURGICAL ASSISTANTS, INC.
Entity Type:Organization
Organization Name:NORTHWEST ASSOCIATION OF SURGICAL ASSISTANTS, INC.
Other - Org Name:NASA
Other - Org Type:Other Name
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:541-683-5000
Mailing Address - Street 1:PO BOX 7382
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475
Mailing Address - Country:US
Mailing Address - Phone:541-683-5000
Mailing Address - Fax:
Practice Address - Street 1:3782 PO BOX
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97475
Practice Address - Country:US
Practice Address - Phone:541-683-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR104266282N00000X
OR101508282N00000X
OR82427282N00000X
OR82440282N00000X
ORF01120282N00000X
OR113006282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1023262995OtherNPI NUMBER
OR1538316963OtherNPI NUMBER
OR1750538864OtherNPI NUMBER
OR1083949697OtherNPI NUMBER
OR1245475136OtherNPI NUMBER
OR1760628796OtherNPI NUMBER