Provider Demographics
NPI:1558583195
Name:NORTHWEST SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:NORTHWEST SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:TRUMAN
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CFA
Authorized Official - Phone:520-404-8562
Mailing Address - Street 1:7230 N LA CHOLLA BLVD
Mailing Address - Street 2:SUITE 154-218
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741
Mailing Address - Country:US
Mailing Address - Phone:520-404-8562
Mailing Address - Fax:
Practice Address - Street 1:7230 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 154-218
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-404-8562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty