Provider Demographics
NPI:1528300423
Name:RINCON SURGICAL FIRST ASSISTS, LLC
Entity type:Organization
Organization Name:RINCON SURGICAL FIRST ASSISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:520-940-4483
Mailing Address - Street 1:PO BOX 14302
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-4302
Mailing Address - Country:US
Mailing Address - Phone:520-940-4483
Mailing Address - Fax:
Practice Address - Street 1:5433 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3108
Practice Address - Country:US
Practice Address - Phone:520-940-4483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN143598163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1851673128OtherPERSONAL NPI