Provider Demographics
NPI:1821248311
Name:ROSS MCDONALD, SURGICAL ASSISTANT-CERTIFIED
Entity Type:Organization
Organization Name:ROSS MCDONALD, SURGICAL ASSISTANT-CERTIFIED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT-CERTIFIED, MEMBE
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:480-221-4907
Mailing Address - Street 1:PO BOX 21449
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-1449
Mailing Address - Country:US
Mailing Address - Phone:480-221-4907
Mailing Address - Fax:
Practice Address - Street 1:1524 E FAIRBROOK ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5028
Practice Address - Country:US
Practice Address - Phone:480-221-4907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06163246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty