Provider Demographics
NPI:1295950103
Name:LITTLE EGYPT SURGICAL ASSISTING L.L.C
Entity type:Organization
Organization Name:LITTLE EGYPT SURGICAL ASSISTING L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERT. REG. NURSE FIRST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:SONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CNOR,CRNFA
Authorized Official - Phone:618-237-8770
Mailing Address - Street 1:1207 N 1ST ST
Mailing Address - Street 2:BOX721
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2466
Mailing Address - Country:US
Mailing Address - Phone:618-237-8770
Mailing Address - Fax:618-847-4206
Practice Address - Street 1:1207 N 1ST ST
Practice Address - Street 2:BOX721
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2466
Practice Address - Country:US
Practice Address - Phone:618-237-8770
Practice Address - Fax:618-847-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0041-282852282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN#