Provider Demographics
NPI:1598133654
Name:PRIME SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:PRIME SURGICAL ASSOCIATES LLC
Other - Org Name:PSAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-916-2295
Mailing Address - Street 1:8321 ALDEN ST
Mailing Address - Street 2:BOX 5
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4213
Mailing Address - Country:US
Mailing Address - Phone:816-916-2295
Mailing Address - Fax:
Practice Address - Street 1:8321 ALDEN ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4213
Practice Address - Country:US
Practice Address - Phone:816-916-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty