Provider Demographics
NPI:1255596086
Name:SURGICAL ASSISTANTS OF DALLAS SUPPLIES, LLC
Entity type:Organization
Organization Name:SURGICAL ASSISTANTS OF DALLAS SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:972-672-8468
Mailing Address - Street 1:10140 ESTATE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2135
Mailing Address - Country:US
Mailing Address - Phone:972-672-8468
Mailing Address - Fax:214-221-0614
Practice Address - Street 1:10140 ESTATE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2135
Practice Address - Country:US
Practice Address - Phone:972-672-8468
Practice Address - Fax:214-221-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z928Medicare PIN