Provider Demographics
NPI:1205232915
Name:PA STAFFING LLC
Entity type:Organization
Organization Name:PA STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:GRASSINO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:314-608-9438
Mailing Address - Street 1:408 BALLWIN AVE
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5213
Mailing Address - Country:US
Mailing Address - Phone:314-608-9438
Mailing Address - Fax:
Practice Address - Street 1:408 BALLWIN AVE
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-5213
Practice Address - Country:US
Practice Address - Phone:314-608-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012008459363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11314003Medicare PIN