Provider Demographics
NPI:1326294166
Name:SOUTHSIDE SURGICAL ASSISTANTS INC
Entity Type:Organization
Organization Name:SOUTHSIDE SURGICAL ASSISTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-969-5735
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:STE 140
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1679
Mailing Address - Country:US
Mailing Address - Phone:480-969-5735
Mailing Address - Fax:480-969-5742
Practice Address - Street 1:227 SANDY SPRINGS PLACE
Practice Address - Street 2:STE D236
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5918
Practice Address - Country:US
Practice Address - Phone:678-641-3232
Practice Address - Fax:678-829-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty