Provider Demographics
NPI:1710978556
Name:M&M SURGICAL ASSISTANTS
Entity Type:Organization
Organization Name:M&M SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RSA
Authorized Official - Phone:630-378-3114
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0636
Mailing Address - Country:US
Mailing Address - Phone:630-378-3114
Mailing Address - Fax:630-378-3118
Practice Address - Street 1:14855 S. VAN DYKE RD
Practice Address - Street 2:SUITE 636
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-4326
Practice Address - Country:US
Practice Address - Phone:630-378-3114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
IL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty