Provider Demographics
NPI:1972784817
Name:PREMIER SURGICAL ASSISTANTS
Entity type:Organization
Organization Name:PREMIER SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-349-0055
Mailing Address - Street 1:10660 W 143RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1989
Mailing Address - Country:US
Mailing Address - Phone:708-349-0055
Mailing Address - Fax:
Practice Address - Street 1:7 CLEARVIEW CT
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-8739
Practice Address - Country:US
Practice Address - Phone:708-349-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty