Provider Demographics
NPI:1134406788
Name:SURGICAL FIRST ASSISTING, LLC
Entity type:Organization
Organization Name:SURGICAL FIRST ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RNFA
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CEMC
Authorized Official - Last Name:PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:CNOR, RNFA
Authorized Official - Phone:541-892-0981
Mailing Address - Street 1:10203 MERLIN WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-8691
Mailing Address - Country:US
Mailing Address - Phone:541-892-0981
Mailing Address - Fax:
Practice Address - Street 1:10203 MERLIN WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-8691
Practice Address - Country:US
Practice Address - Phone:541-892-0981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200641523RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty