Provider Demographics
NPI:1871832949
Name:PROFESSIONAL SURGICAL ASSISTING SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL SURGICAL ASSISTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C, KCSA
Authorized Official - Phone:270-202-9006
Mailing Address - Street 1:116 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-5120
Mailing Address - Country:US
Mailing Address - Phone:270-202-9006
Mailing Address - Fax:800-497-4153
Practice Address - Street 1:1301 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3454
Practice Address - Country:US
Practice Address - Phone:270-651-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0626254246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty