Provider Demographics
NPI:1912344607
Name:KEYSTONE SURGICAL ASSISTANTS INC.
Entity type:Organization
Organization Name:KEYSTONE SURGICAL ASSISTANTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOBST
Authorized Official - Suffix:III
Authorized Official - Credentials:CSA
Authorized Official - Phone:570-417-8831
Mailing Address - Street 1:200 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1143
Mailing Address - Country:US
Mailing Address - Phone:570-899-5605
Mailing Address - Fax:570-821-1105
Practice Address - Street 1:200 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1143
Practice Address - Country:US
Practice Address - Phone:570-899-5605
Practice Address - Fax:570-821-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty