Provider Demographics
NPI:1790062495
Name:SMITH SURGICAL ASSISTING, LLC
Entity Type:Organization
Organization Name:SMITH SURGICAL ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:KCSA
Authorized Official - Phone:336-623-4545
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289-0148
Mailing Address - Country:US
Mailing Address - Phone:336-623-4545
Mailing Address - Fax:336-623-6141
Practice Address - Street 1:3029 WEDGEWOOD WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1731
Practice Address - Country:US
Practice Address - Phone:502-648-0213
Practice Address - Fax:336-623-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA218246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty