Provider Demographics
NPI:1912315763
Name:SPECTRUM SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:SPECTRUM SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CSA
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSA
Authorized Official - Phone:386-960-4534
Mailing Address - Street 1:146 MARTIN LUTHER KING JR BLVD #302
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655
Mailing Address - Country:US
Mailing Address - Phone:386-479-9575
Mailing Address - Fax:
Practice Address - Street 1:146 MARTIN LUTHER KING JR BLVD #302
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:386-479-9575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty