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SOUTHEAST FIRST ASSISTANT LLC
NPI 1790158459
Physician Assistant - Surgical in Athol, ID

Active since November 03, 2015
12473 E NUNN RD, ATHOL, ID 83801(208) 215-6411 Get Directions Write a Review

NPPES record last updated: November 3, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Southeast First Assistant Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST FIRST ASSISTANT LLC (NPI 1790158459) is a healthcare organization registered as a surgical in Athol, Idaho and active in the NPI registry since November 2015. The organization lists Drew Johnson, Owner, as its authorized official.

NPPES Registry Identity

NPI1790158459
Entity TypeOrganization
Primary Taxonomy363AS0400X
Legal Business NameSOUTHEAST FIRST ASSISTANT LLC
Location Address12473 E NUNN RDAthol, ID 83801-9311
Mailing Address12473 E Nunn RdAthol, ID 83801-9311
Phone(208) 215-6411
Organization SubpartNo
Authorized OfficialDrew JohnsonOwner · (208) 215-6411
Enumeration DateNovember 3, 2015
✔ NPI 1790158459 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in ID · PA-1167
Also ListedPhysician AssistantTaxonomy 363A00000X · License PA-1167 (ID)
12473 E NUNN RD, Athol, ID 83801
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Other Identifiers 1

OtherPA-1167ID · Idaho License

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeast First Assistant LLC's NPI number?

The NPI number for Southeast First Assistant LLC is 1790158459. It was assigned to this organization in the NPPES registry on November 3, 2015.

Where is Southeast First Assistant LLC located?

Southeast First Assistant LLC is located at 12473 E Nunn Rd, Athol, ID 83801. The listed phone number is (208) 215-6411.

What is Southeast First Assistant LLC's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

When was this NPI record last updated?

The NPPES record for Southeast First Assistant LLC was last updated on November 3, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.