Provider Demographics
NPI:1366141590
Name:KEG SURGICAL ASSISTING, LLC
Entity type:Organization
Organization Name:KEG SURGICAL ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CST, CSFA
Authorized Official - Prefix:
Authorized Official - First Name:KYRRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIS
Authorized Official - Suffix:
Authorized Official - Credentials:CST, CSFA
Authorized Official - Phone:308-379-6727
Mailing Address - Street 1:4905 W OLD POTASH HWY
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-9026
Mailing Address - Country:US
Mailing Address - Phone:308-379-6727
Mailing Address - Fax:
Practice Address - Street 1:4905 W OLD POTASH HWY
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-9026
Practice Address - Country:US
Practice Address - Phone:308-379-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty