Provider Demographics
NPI:1669420048
Name:SURGICAL ASSIST,L.L.C.
Entity type:Organization
Organization Name:SURGICAL ASSIST,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JR
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:804-239-8208
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1041
Mailing Address - Country:US
Mailing Address - Phone:804-239-8208
Mailing Address - Fax:804-249-9132
Practice Address - Street 1:3913 MORTON DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1287
Practice Address - Country:US
Practice Address - Phone:804-239-8208
Practice Address - Fax:804-249-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3123363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty