Provider Demographics
NPI:1548453558
Name:SURGICAL ASSISTANT SERVICES, INC.
Entity type:Organization
Organization Name:SURGICAL ASSISTANT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/RNFA
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-506-6870
Mailing Address - Street 1:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-2264
Mailing Address - Country:US
Mailing Address - Phone:971-506-6870
Mailing Address - Fax:503-642-9434
Practice Address - Street 1:9432 SW 164TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9415
Practice Address - Country:US
Practice Address - Phone:971-506-6870
Practice Address - Fax:503-642-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094000296RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240297Medicaid
OR341686OtherPROVIDENCE HEALTH PLANS