1295950103 NPI number — LITTLE EGYPT SURGICAL ASSISTING L.L.C

Table of content: (NPI 1295950103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295950103 NPI number — LITTLE EGYPT SURGICAL ASSISTING L.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE EGYPT SURGICAL ASSISTING L.L.C
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:
Provider Other Organization Name Type Code:
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:
1295950103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1207 N 1ST ST
Provider Second Line Business Mailing Address:
BOX721
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62837-2466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-237-8770
Provider Business Mailing Address Fax Number:
618-847-4206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1207 N 1ST ST
Provider Second Line Business Practice Location Address:
BOX721
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62837-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-237-8770
Provider Business Practice Location Address Fax Number:
618-847-4206
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SONS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
RENAE
Authorized Official Title or Position:
CERT. REG. NURSE FIRST ASSISTANT
Authorized Official Telephone Number:
618-237-8770

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0041-282852 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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