Provider Demographics
NPI:1275268344
Name:STEWART SURGICAL ASSISTING
Entity Type:Organization
Organization Name:STEWART SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYBOL
Authorized Official - Middle Name:ESTELLE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:505-401-7827
Mailing Address - Street 1:3 ROCK ROSE CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-7012
Mailing Address - Country:US
Mailing Address - Phone:505-401-7827
Mailing Address - Fax:
Practice Address - Street 1:4701 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1219
Practice Address - Country:US
Practice Address - Phone:505-401-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYBOL ESTELLE STEWART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty