Provider Demographics
NPI:1013357250
Name:ANGELINA SURGICAL ASSISTANTS LLC
Entity Type:Organization
Organization Name:ANGELINA SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREFUS
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:CSFA, RN
Authorized Official - Phone:936-526-1315
Mailing Address - Street 1:PO BOX 155854
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-5854
Mailing Address - Country:US
Mailing Address - Phone:936-526-1315
Mailing Address - Fax:936-634-8515
Practice Address - Street 1:2900 ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-1524
Practice Address - Country:US
Practice Address - Phone:936-526-1315
Practice Address - Fax:936-634-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX856051163W00000X
TX130937246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty