Provider Demographics
NPI:1184894768
Name:SURGENCY PHYSICIAN ASSISTANT PLLC
Entity type:Organization
Organization Name:SURGENCY PHYSICIAN ASSISTANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-615-9082
Mailing Address - Street 1:3145 E CHANDLER BLVD # 110-207
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8702
Mailing Address - Country:US
Mailing Address - Phone:602-615-9082
Mailing Address - Fax:
Practice Address - Street 1:3145 E CHANDLER BLVD # 110-207
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8702
Practice Address - Country:US
Practice Address - Phone:602-615-9082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty