Provider Demographics
NPI:1811290174
Name:B & B SURGICAL ASSISTANCE PLLC
Entity type:Organization
Organization Name:B & B SURGICAL ASSISTANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:480-980-8206
Mailing Address - Street 1:PO BOX 50924
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-0924
Mailing Address - Country:US
Mailing Address - Phone:480-980-8206
Mailing Address - Fax:480-281-5224
Practice Address - Street 1:15060 S 39TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6612
Practice Address - Country:US
Practice Address - Phone:480-980-8206
Practice Address - Fax:480-281-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ096553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ816473Medicaid