Provider Demographics
NPI:1972958767
Name:PREMIER SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:PREMIER SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-251-1309
Mailing Address - Street 1:10297 SW WEST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2118
Mailing Address - Country:US
Mailing Address - Phone:561-251-1309
Mailing Address - Fax:772-345-6120
Practice Address - Street 1:10297 SW WEST PARK AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2118
Practice Address - Country:US
Practice Address - Phone:561-251-1309
Practice Address - Fax:772-345-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty