Provider Demographics
NPI:1558786921
Name:NEW TAMPA SURGICAL ASSISTANCE, LLC
Entity Type:Organization
Organization Name:NEW TAMPA SURGICAL ASSISTANCE, LLC
Other - Org Name:EDUARDO RUSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:CLEAVON
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:813-748-9474
Mailing Address - Street 1:18002 RICHMOND PLACE DR
Mailing Address - Street 2:APT 2425
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1724
Mailing Address - Country:US
Mailing Address - Phone:813-748-9474
Mailing Address - Fax:813-975-0175
Practice Address - Street 1:18002 RICHMOND PLACE DR
Practice Address - Street 2:APT 2425
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1724
Practice Address - Country:US
Practice Address - Phone:813-748-9474
Practice Address - Fax:813-975-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty