PREMIER SURGICAL ASSIST, INC. (NPI# 1538781703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538781703 |
| Entity Type | Organization |
| Organization Name | PREMIER SURGICAL ASSIST, INC. |
| Practice Address |
4605 Maccorkle Ave Sw South Charleston WV 25309-1311 |
| Mailing Address |
11157 Charleston Rd Red House WV 25168-7505 |
| Practice Telephone | 3043897914 |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-05-11 |
| Authorized Official Name | MR. GENO ANTHONY SANTANGELO JR. (CO-OWNER) |
| Authorized Official Telephone | 3043897914 |
| Authorized Official Credential | PA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1306 Kanawha Blvd E, Charleston, WV 253013001 | 3043897914 |
| Street Address |
4605 MACCORKLE AVE SW |
| City | SOUTH CHARLESTON |
| State | WV |
| Zip Code | 25309-1311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164425542 | David Abramowitz | Radiology | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2005-05-31 |
| 1609494269 | Tabitha Michelle Spence | Nurse Practitioner | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2020-07-10 |
| 1629690037 | Stephanie Shamma | Nurse Practitioner | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1398 | 2020-05-08 |
| 1174187603 | Herbert J Thomas Memorial Hospital Association | Substance Abuse Rehabilitation Facility | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2019-04-30 |
| 1659856383 | Maccorkle Emergency Physicians Pllc | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-09-28 |
| 1386122844 | Hospitalist Medicine Physicians of West Virginia- Tcg, Pllc | Internal Medicine | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-08-06 |
| 1245717222 | Kelsey Leigh Higgins | Speech-Language Pathologist | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-07-23 |
| 1982180709 | Samantha Craigo | Speech-Language Pathologist | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-07-15 |
| 1316430564 | Nicholas E. Clark | Nurse Anesthetist, Certified Registered | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-06-12 |
| 1568970911 | Laura Vickie Powers | Nurse Anesthetist, Certified Registered | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-01-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619973096 | Michael M Boustany | Surgery | 434 Division St, South Charleston, WV 25309 | 2005-06-22 |
| 1003013681 | Comprehensive Surgical Associates Pllc | Surgery | 500 Poplar St, Suite 304, South Charleston, WV 25309-1474 | 2007-06-28 |
| 1255537999 | Johnna Michelle Jackson | Surgery | 500 Poplar St, Suite 304, South Charleston, WV 25309-1474 | 2007-06-21 |
| 1942429790 | Kristen Price Eads | Surgery | 500 Poplar St, Suite 304, South Charleston, WV 25309-1474 | 2007-04-24 |
| 1568426310 | Delphi Healthcare Partners, Inc. D/b/a South Charleston Surgicalists | Surgery | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2006-04-17 |
| 1689670069 | Ahmad Bali | Surgery | 401 Division St, Suite 202, South Charleston, WV 25309-1455 | 2005-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417476920 | Raleigh General Hospital LLC | Surgery | 1717 Harper Rd Ste Ab, Beckley, WV 25801-3373 | 2017-09-15 |
| 1043690712 | Onyechi Megafu | Surgery | 2900 1st Ave Ste 210, Huntington, WV 25702-1241 | 2015-06-08 |
| 1548653892 | Parinya Taupradist | Surgery | 1909 Woodside Cir, Charleston, WV 25314-2255 | 2015-03-11 |
| 1730437716 | Akkary Center for Weight Management & Surgical Services | Surgery | 1100 Fort Pierpont Dr, Morgantown, WV 26508-1329 | 2012-08-21 |
| 1669735890 | Semeret Tadios Munie | Surgery | 1115 20th St Ste 101, Huntington, WV 25703-2071 | 2012-06-22 |
| 1780962704 | Pineview Surgery Pllc | Surgery | 1311 Pineview Dr Ste 200, Morgantown, WV 26505-3276 | 2011-07-25 |
| 1659685246 | Suratkal V Shenoy Md PC | Surgery | Rt 220 South and Staggs Lane, Keyser, WV 26726 | 2010-08-06 |
| 1467776013 | John Gabriel Maijub | Surgery | 609 22nd St Apt 1431, Huntington, WV 25703-1657 | 2010-03-24 |
| 1417196262 | Fernando Dominguez | Surgery | 507 Forest Road, Huntington, WV 25705 | 2009-02-18 |
| 1497907141 | Porfirio R. Pascasio | Surgery | 2880 North Pleasant Highway, St. Mary's Correctional Center, St. Mary, WV 26170 | 2008-10-14 |
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| City | SOUTH CHARLESTON |
| Zip Code | 25309 |
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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.