Provider Demographics
NPI:1720523855
Name:NORTH IDAHO SURGICAL ASSISTANT ASSOCIATION
Entity Type:Organization
Organization Name:NORTH IDAHO SURGICAL ASSISTANT ASSOCIATION
Other - Org Name:PRECISION PEACH SURGICAL ASSISTANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:THULON
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:208-762-2097
Mailing Address - Street 1:27 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5210
Mailing Address - Country:US
Mailing Address - Phone:208-762-2097
Mailing Address - Fax:
Practice Address - Street 1:27 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5210
Practice Address - Country:US
Practice Address - Phone:208-762-2097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes281P00000XHospitalsChronic Disease Hospital
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty