Provider Demographics
NPI:1700110889
Name:SAS ANCILLARY SERVICES LLC
Entity Type:Organization
Organization Name:SAS ANCILLARY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:FORRISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-736-3028
Mailing Address - Street 1:3100 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1890
Mailing Address - Country:US
Mailing Address - Phone:770-736-3028
Mailing Address - Fax:770-736-3345
Practice Address - Street 1:3100 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE 202
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1890
Practice Address - Country:US
Practice Address - Phone:770-736-3028
Practice Address - Fax:770-736-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6440530001Medicare NSC