Provider Demographics
NPI:1861627952
Name:JB SURGICAL ASSISTANCE INC
Entity Type:Organization
Organization Name:JB SURGICAL ASSISTANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BONNET
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:561-213-9372
Mailing Address - Street 1:8950 ALEXANDRA CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6438
Mailing Address - Country:US
Mailing Address - Phone:561-231-9372
Mailing Address - Fax:866-277-6962
Practice Address - Street 1:8950 ALEXANDRA CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6438
Practice Address - Country:US
Practice Address - Phone:561-231-9372
Practice Address - Fax:866-277-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP05705Medicare UPIN