Provider Demographics
NPI: | 1457587545 |
---|---|
Name: | FIRST ASSISTANTS RELIABLY THERE LLC |
Entity Type: | Organization |
Organization Name: | FIRST ASSISTANTS RELIABLY THERE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SOLE PROP. |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | SPENCER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CFA |
Authorized Official - Phone: | 928-310-8146 |
Mailing Address - Street 1: | 1401 N NAVAJO DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FLAGSTAFF |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 86001-1205 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 928-310-8146 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1200 N BEAVER ST |
Practice Address - Street 2: | |
Practice Address - City: | FLAGSTAFF |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 86001-3118 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-779-3366 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-06-03 |
Last Update Date: | 2009-06-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 246ZS0410X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Surgical Technologist | Group - Multi-Specialty |