Jason Fort, CST/CSA

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

License

L18709787 Issued in AZ

Practice address

2778 E Superior Rd
San Tan Valley, AZ 85143-4573

Phone

(480) 313-9045

Fax

(480) 987-2186

NPI assigned

Jan 16, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1417228909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2778 E SUPERIOR RD",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851434573",
            "telephone_number": "480-313-9045",
            "fax_number": "480-987-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2778 E SUPERIOR RD",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851434573",
            "telephone_number": "480-313-9045",
            "fax_number": "480-987-2186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORT",
        "first_name": "JASON",
        "credential": "CST/CSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-16",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "OR",
            "license": "454110172",
            "primary": false
        },
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "AZ",
            "license": "L18709787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Technologist in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Surgical Technologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.