Provider Demographics
NPI:1528606084
Name:SUPERIOR SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SUPERIOR SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BASHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:573-410-2908
Mailing Address - Street 1:14141 AZALEA PARK AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1674
Mailing Address - Country:US
Mailing Address - Phone:573-410-2908
Mailing Address - Fax:
Practice Address - Street 1:14141 AZALEA PARK AVE APT C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1674
Practice Address - Country:US
Practice Address - Phone:573-410-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty