Provider Demographics
NPI:1538781703
Name:PREMIER SURGICAL ASSIST, INC.
Entity type:Organization
Organization Name:PREMIER SURGICAL ASSIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GENO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:304-389-7914
Mailing Address - Street 1:11157 CHARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:RED HOUSE
Mailing Address - State:WV
Mailing Address - Zip Code:25168-7505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4605 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-389-7914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty