Provider Demographics
NPI:1124678602
Name:F&G AMERICAN SURGICAL ASSISTANTS SERVICES LLC
Entity type:Organization
Organization Name:F&G AMERICAN SURGICAL ASSISTANTS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR/AMBR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHANS
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:407-755-9495
Mailing Address - Street 1:1625 S KIRKMAN RD APT 9204
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2579
Mailing Address - Country:US
Mailing Address - Phone:407-755-9495
Mailing Address - Fax:407-395-2587
Practice Address - Street 1:1625 S KIRKMAN RD APT 9204
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2579
Practice Address - Country:US
Practice Address - Phone:407-926-0010
Practice Address - Fax:407-395-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty