Provider Demographics
NPI:1487799144
Name:ALPHA SURGICAL ASSIST, LLC
Entity type:Organization
Organization Name:ALPHA SURGICAL ASSIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED FIRST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:CFA
Authorized Official - Phone:520-861-0481
Mailing Address - Street 1:PO BOX 64087
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-4087
Mailing Address - Country:US
Mailing Address - Phone:520-861-0481
Mailing Address - Fax:520-696-1718
Practice Address - Street 1:4015 N FREMONT AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1065
Practice Address - Country:US
Practice Address - Phone:520-861-0481
Practice Address - Fax:520-696-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty