Provider Demographics
NPI:1457714388
Name:CERTIFIED SURGICAL FIRST ASSISTANT
Entity Type:Organization
Organization Name:CERTIFIED SURGICAL FIRST ASSISTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-545-2610
Mailing Address - Street 1:2925 E RIGGS RD
Mailing Address - Street 2:STE 8-166
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3600
Mailing Address - Country:US
Mailing Address - Phone:602-909-4623
Mailing Address - Fax:480-545-2673
Practice Address - Street 1:2925 E RIGGS RD
Practice Address - Street 2:STE 8-166
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3600
Practice Address - Country:US
Practice Address - Phone:480-545-2610
Practice Address - Fax:480-545-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty