Provider Demographics
NPI:1003352840
Name:PROSURG SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:PROSURG SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARVER
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:214-906-2875
Mailing Address - Street 1:3077 N GOLIAD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-7050
Mailing Address - Country:US
Mailing Address - Phone:214-906-2875
Mailing Address - Fax:972-771-1825
Practice Address - Street 1:3077 N GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7050
Practice Address - Country:US
Practice Address - Phone:214-906-2875
Practice Address - Fax:972-771-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168736363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty