Provider Demographics
NPI:1528769098
Name:SURGICAL PA, LLC
Entity type:Organization
Organization Name:SURGICAL PA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:253-888-9077
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-0347
Mailing Address - Country:US
Mailing Address - Phone:253-888-9077
Mailing Address - Fax:
Practice Address - Street 1:413 LILLY RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2108
Practice Address - Country:US
Practice Address - Phone:253-888-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty