1013336569 NPI number — FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI

Table of content: (NPI 1013336569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013336569 NPI number — FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FASSMO
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013336569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 271071
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80027-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
566 S. MCCASLIN BLVD.
Provider Second Line Business Practice Location Address:
SUITE 271071
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-639-4188
Provider Business Practice Location Address Fax Number:
720-639-4188
Provider Enumeration Date:
04/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SHERWOOD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
SURGICAL ASSISTANT / OWNER
Authorized Official Telephone Number:
720-639-4188

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com