Provider Demographics
NPI:1881907632
Name:KSG FIRST ASSISTANTS
Entity type:Organization
Organization Name:KSG FIRST ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTEREDNURSE FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA, MSN
Authorized Official - Phone:575-921-8554
Mailing Address - Street 1:4663 DEL NORTE CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6924
Mailing Address - Country:US
Mailing Address - Phone:575-921-8554
Mailing Address - Fax:
Practice Address - Street 1:4663 DEL NORTE CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-6924
Practice Address - Country:US
Practice Address - Phone:575-921-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR58667163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11869309Medicare UPIN