Provider Demographics
NPI:1295191351
Name:DUKE CITY SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:DUKE CITY SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-280-5326
Mailing Address - Street 1:28 VALLE LINDO RD
Mailing Address - Street 2:
Mailing Address - City:PERALTA
Mailing Address - State:NM
Mailing Address - Zip Code:87042-8230
Mailing Address - Country:US
Mailing Address - Phone:505-280-5326
Mailing Address - Fax:
Practice Address - Street 1:28 VALLE LINDO RD
Practice Address - Street 2:
Practice Address - City:PERALTA
Practice Address - State:NM
Practice Address - Zip Code:87042-8230
Practice Address - Country:US
Practice Address - Phone:505-280-5326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty