# DIRECT SURGICAL ASSIST PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194017954
- **Authorized official:** MR. JEFFREY DALE SMITH PA-C (PRESIDENT)
- **Authorized official phone:** (208) 989-0598

## Contact information

- **Practice address:** 695 N ASPEN LAKES WAY, STAR, ID 83669-5674
- **Practice address phone:** (208) 989-0598
- **Mailing address:** 695 N ASPEN LAKES WAY, STAR, ID 83669-5674
- **Mailing address phone:** (208) 989-0598

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 05/11/2011
- **Last updated:** 05/11/2011