Provider Demographics
NPI:1275297509
Name:MONARCHM.A.GSURGICALFIRSTASSISTANTSERVICES LLC
Entity Type:Organization
Organization Name:MONARCHM.A.GSURGICALFIRSTASSISTANTSERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA-CST
Authorized Official - Phone:517-281-4657
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-0365
Mailing Address - Country:US
Mailing Address - Phone:517-281-4657
Mailing Address - Fax:
Practice Address - Street 1:1025 PHAY AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2246
Practice Address - Country:US
Practice Address - Phone:517-281-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty