Provider Demographics
NPI:1689026247
Name:SOUTHPOINTE SURGICAL ASSIST, L.L.C.
Entity Type:Organization
Organization Name:SOUTHPOINTE SURGICAL ASSIST, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:907-331-8551
Mailing Address - Street 1:6436 SOUTHPOINTE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-6219
Mailing Address - Country:US
Mailing Address - Phone:907-331-8551
Mailing Address - Fax:
Practice Address - Street 1:6436 SOUTHPOINTE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-6219
Practice Address - Country:US
Practice Address - Phone:907-331-8551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty