Provider Demographics
NPI:1730791104
Name:CAPITAL REGION SURGICAL ASSISTANTS LLC
Entity type:Organization
Organization Name:CAPITAL REGION SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSA, CSFA, LSA
Authorized Official - Phone:443-910-0033
Mailing Address - Street 1:903 HILLSIDE LAKE TER APT 605
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5242
Mailing Address - Country:US
Mailing Address - Phone:443-910-0033
Mailing Address - Fax:
Practice Address - Street 1:903 HILLSIDE LAKE TER APT 605
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5242
Practice Address - Country:US
Practice Address - Phone:443-910-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty