Provider Demographics
NPI:1114729688
Name:ELITE SURGICAL ASSIST
Entity type:Organization
Organization Name:ELITE SURGICAL ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE FIRST ASSIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:478-697-0436
Mailing Address - Street 1:3321 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8005
Mailing Address - Country:US
Mailing Address - Phone:478-697-0436
Mailing Address - Fax:
Practice Address - Street 1:3321 N 10TH ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-8005
Practice Address - Country:US
Practice Address - Phone:478-697-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty