Provider Demographics
NPI:1154793248
Name:ELITE SURGICAL ASSISTING LLC
Entity type:Organization
Organization Name:ELITE SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-965-8622
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:NEW MELLE
Mailing Address - State:MO
Mailing Address - Zip Code:63365-0323
Mailing Address - Country:US
Mailing Address - Phone:888-826-4546
Mailing Address - Fax:888-826-4546
Practice Address - Street 1:2355 DOUGHERTY FERRY RD STE 430
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3325
Practice Address - Country:US
Practice Address - Phone:888-826-4546
Practice Address - Fax:888-826-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty