OrganizationActive
Southeast First Assistant LLC
NPI 1790158459 · Surgical Physician Assistant · Athol, ID
Provider details
- NPI number
- 1790158459
- Entity type
- Organization
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Drew Johnson, Owner(208) 215-6411
- License
- PA-1167 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
12473 E Nunn Rd
Athol, ID 83801-9311
Phone: (208) 215-6411
Approximate (ZIP-level) locationGet directions
Mailing address
12473 E Nunn Rd
Athol, ID 83801-9311
Registry dates
- Enumerated
- 2015-11-03
- Last updated
- 2015-11-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.