Provider Demographics
NPI:1356520407
Name:GSP SURGICAL ASSISTANTS, INC
Entity type:Organization
Organization Name:GSP SURGICAL ASSISTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:941-914-6610
Mailing Address - Street 1:PO BOX 50922
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0307
Mailing Address - Country:US
Mailing Address - Phone:941-914-6610
Mailing Address - Fax:941-866-8121
Practice Address - Street 1:5682 BENTGRASS DR
Practice Address - Street 2:UNIT 212
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-7643
Practice Address - Country:US
Practice Address - Phone:941-914-6610
Practice Address - Fax:941-866-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP04000127074363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6840Medicare PIN