Southeast First Assistant LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA-1167 Issued in ID

Legal business name

SOUTHEAST FIRST ASSISTANT LLC

Practice address

12473 E Nunn Rd
Athol, ID 83801-9311

Phone

(208) 215-6411

NPI assigned

Nov 3, 2015

Last updated

Nov 3, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Drew Johnson, PAC

Title

Owner

Phone

(208) 215-6411

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

Southeast First Assistant LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southeast First Assistants Inc

  • Registered Nurse First Assistant
  • Hendersonville, NC
  • NPI 1093926867
  NPD tax ID

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

{
    "created_epoch": "1446508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446508800000",
    "number": "1790158459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12473 E NUNN RD",
            "city": "ATHOL",
            "state": "ID",
            "postal_code": "838019311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12473 E NUNN RD",
            "city": "ATHOL",
            "state": "ID",
            "postal_code": "838019311",
            "telephone_number": "208-215-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST FIRST ASSISTANT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-03",
        "last_updated": "2015-11-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-215-6411",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1167",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-1167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO LICENSE",
            "identifier": "PA-1167",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Idaho Day Surgery LLC
• Lynne Kaulback Orange, M.ED., CCC-SLP
• Hayden Kevin Sharp, DDS
• Smiles 4 Miles, LLC
• Kelly Sorensen, IBCLC
• Charla-Jo Olorenshaw Spradlin, PT
• Amie Lee Storm, LM, CPM
• Christopher Ray Sundquist, PAC
• Timberlake Family Medicine
• True North MHW LLC (True North Mental Health & Wellness)

• Surgical Physician Assistant in Athol, ID
• Providers in Athol, ID by specialty
• Surgical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; 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.