Provider Demographics
NPI:1053762674
Name:SYNERGY SURGICAL ASSISTING LLC
Entity type:Organization
Organization Name:SYNERGY SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MAGILL
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:928-965-2840
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-0407
Mailing Address - Country:US
Mailing Address - Phone:928-965-2840
Mailing Address - Fax:
Practice Address - Street 1:1600 S 20TH AVE # 85546
Practice Address - Street 2:SURGERY DEPARTMENT
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4011
Practice Address - Country:US
Practice Address - Phone:928-965-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty