Provider Demographics
NPI:1013336569
Name:FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI
Entity Type:Organization
Organization Name:FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI
Other - Org Name:FASSMO
Other - Org Type:Other Name
Authorized Official - Title/Position:SURGICAL ASSISTANT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:720-639-4188
Mailing Address - Street 1:PO BOX 271071
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:566 S. MCCASLIN BLVD.
Practice Address - Street 2:SUITE 271071
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:720-639-4188
Practice Address - Fax:720-639-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty