TRI-STATE SURGICAL ASSOCIATES (NPI# 1356622583) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356622583 |
| Entity Type | Organization |
| Organization Name | TRI-STATE SURGICAL ASSOCIATES |
| Practice Address |
10332 Main St # 344 Fairfax VA 22030-2410 |
| Practice Telephone | 5712444684 |
| Mailing Telephone | 5712444684 |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2014-02-22 |
| Authorized Official Name | CARLOS MEZA-VALENCIA (OWNER, PRESIDENT) |
| Authorized Official Telephone | 5712444684 |
| Authorized Official Credential | C-SA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
10332 MAIN ST # 344 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205355468 | Kortney Jamal Richardson Readus | Specialist/Technologist, Other | 10332 Main St # 344, Fairfax, VA 22030-2410 | 2017-09-19 |
| 1700234325 | Louis Kalisch | Physician Assistant | 10332 Main St # 344, Fairfax, VA 22030-2410 | 2016-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871976522 | Hall Surgical Assistance, LLC | Physician Assistant | 10332 Main St, Suite #344, Fairfax, VA 22030-2410 | 2015-06-30 |
| 1306234638 | Metropolitan Surgical Assist | Physician Assistant | 2826 Old Lee Highway, Suite 330, Fairfax, VA 22031 | 2015-01-09 |
| 1417253816 | Esam Al Nouman | Physician Assistant | 2903 Roseline Rd, Fairfax, VA 22033-5602 | 2011-02-02 |
| 1427406727 | Peggy Vollstad | Physician Assistant | 3023 Hamaker Ct, Suite 200, Fairfax, VA 22031-2207 | 2016-05-26 |
| 1700234325 | Louis Kalisch | Physician Assistant | 10332 Main St # 344, Fairfax, VA 22030-2410 | 2016-05-25 |
| 1205242419 | Megan Condrey | Physician Assistant | 2826 Old Lee Hwy, Ste. 330, Fairfax, VA 22031-4323 | 2014-07-08 |
| 1811297807 | Douglas Trott | Physician Assistant | 12011 Lee Jackson Hwy, Fairfax, VA 22033-3335 | 2010-10-25 |
| 1548423643 | Luis I. Quinones | Physician Assistant | 12011 Lee Jackson Hwy, 4th Floor Spine Surgery, Fairfax, VA 22033-3310 | 2008-07-08 |
| 1881819498 | Mary Elizabeth Zempolich | Physician Assistant | 3650 Joseph Siewick Dr Ste 200, Fairfax, VA 22033-1712 | 2007-04-17 |
| 1225046303 | Josilu Portella | Physician Assistant | 3620 Joseph Siewick Dr, Suite 406, Fairfax, VA 22033-1756 | 2006-08-04 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.