Provider Demographics
NPI:1053667600
Name:NEUROLOGICAL SURGICAL ASSISTING, LLC
Entity type:Organization
Organization Name:NEUROLOGICAL SURGICAL ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIEF
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:402-770-8027
Mailing Address - Street 1:5204 E WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1198
Mailing Address - Country:US
Mailing Address - Phone:402-770-8027
Mailing Address - Fax:
Practice Address - Street 1:5204 E WALLACE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1198
Practice Address - Country:US
Practice Address - Phone:480-980-8206
Practice Address - Fax:480-281-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5122363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty