Provider Demographics
NPI:1336804863
Name:IRON MAIDEN SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:IRON MAIDEN SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAISEY
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:505-639-3010
Mailing Address - Street 1:6401 SANTA MONICA AVE NE APT 3013
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4168
Mailing Address - Country:US
Mailing Address - Phone:505-639-3010
Mailing Address - Fax:
Practice Address - Street 1:4999 DREAM DANCER DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-0851
Practice Address - Country:US
Practice Address - Phone:505-639-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-31
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty