Organization
SURGICAL FIRST ASSIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM CLARK CSA (CERTIFIED SURGICAL ASSISTANT / OWNE)
(901) 590-5968
Entity
Organization
Contact information
Practice address
8921 BLACK PANTHER COVE, HERENANDO, MS 38632
(901) 590-5968
Mailing address
8921 BLACK PANTHER COVE, HERENANDO, MS 38632
(901) 590-5968
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487886834
INDVIDUAL NPI BEFORE LLC FORMATION
—
Enumeration date
07/26/2012
Last updated
07/26/2012
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