Provider Demographics
NPI:1194923342
Name:PREMIER SURGICAL FIRST ASSISTANT LLC
Entity type:Organization
Organization Name:PREMIER SURGICAL FIRST ASSISTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:FA
Authorized Official - Phone:913-541-1228
Mailing Address - Street 1:15242 W 82ND TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1501
Mailing Address - Country:US
Mailing Address - Phone:913-541-1228
Mailing Address - Fax:913-439-1942
Practice Address - Street 1:15242 W 82ND TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1501
Practice Address - Country:US
Practice Address - Phone:913-541-1228
Practice Address - Fax:913-439-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty