Provider Demographics
NPI:1659172724
Name:CHARLES'S SURGICAL ASSISTANT GROUP LLC
Entity type:Organization
Organization Name:CHARLES'S SURGICAL ASSISTANT GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NONO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:PA, SA-C
Authorized Official - Phone:954-451-8504
Mailing Address - Street 1:335 NW 34TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2820
Mailing Address - Country:US
Mailing Address - Phone:954-451-8504
Mailing Address - Fax:
Practice Address - Street 1:335 NW 34TH ST APT 203
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2820
Practice Address - Country:US
Practice Address - Phone:954-451-8504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty