Provider Demographics
NPI:1932582475
Name:KRYSTLE BARTON SURGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:KRYSTLE BARTON SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:719-557-2290
Mailing Address - Street 1:8300 GREENSBORO DR
Mailing Address - Street 2:SUITE L1 #638
Mailing Address - City:TYSONS CORNER
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3605
Mailing Address - Country:US
Mailing Address - Phone:719-557-2290
Mailing Address - Fax:
Practice Address - Street 1:8300 GREENSBORO DR
Practice Address - Street 2:SUITE L1 #638
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22102-3605
Practice Address - Country:US
Practice Address - Phone:719-557-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty