Provider Demographics
NPI:1427592385
Name:NORTHSHORE SURGICAL ASSISTING
Entity type:Organization
Organization Name:NORTHSHORE SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:985-707-3017
Mailing Address - Street 1:70458 SILAS THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452
Mailing Address - Country:UM
Mailing Address - Phone:985-707-3017
Mailing Address - Fax:
Practice Address - Street 1:70458 SILAS THOMAS RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-2460
Practice Address - Country:US
Practice Address - Phone:985-707-3017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA123842246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty