Provider Demographics
NPI:1124729785
Name:PRIME TIME SURGICAL ASSISTING AND CONSULTING LLC
Entity type:Organization
Organization Name:PRIME TIME SURGICAL ASSISTING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAREL
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:CST, LSA
Authorized Official - Phone:720-955-0456
Mailing Address - Street 1:PO BOX 440216
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80044-0216
Mailing Address - Country:US
Mailing Address - Phone:720-955-0456
Mailing Address - Fax:
Practice Address - Street 1:14231 E 1ST DR UNIT 203
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-3818
Practice Address - Country:US
Practice Address - Phone:720-955-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty