Provider Demographics
NPI:1346941804
Name:PROFESSIONAL SURGICAL ASSISTANTS, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL SURGICAL ASSISTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:RENTON
Authorized Official - Suffix:
Authorized Official - Credentials:CSA, KCSA
Authorized Official - Phone:812-923-2050
Mailing Address - Street 1:107 TUNNEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9131
Mailing Address - Country:US
Mailing Address - Phone:812-923-2050
Mailing Address - Fax:812-923-2883
Practice Address - Street 1:107 TUNNEL HILL RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9131
Practice Address - Country:US
Practice Address - Phone:812-923-2050
Practice Address - Fax:812-923-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty