Provider Demographics
NPI:1134465057
Name:BIG SKY FIRST ASSISTS, LLC.
Entity type:Organization
Organization Name:BIG SKY FIRST ASSISTS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMOLENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-782-6900
Mailing Address - Street 1:333 N DOBSON RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4412
Mailing Address - Country:US
Mailing Address - Phone:480-782-6900
Mailing Address - Fax:480-782-6905
Practice Address - Street 1:333 N DOBSON RD
Practice Address - Street 2:STE.15
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:480-782-6900
Practice Address - Fax:480-782-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4994363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty