Provider Demographics
NPI:1093037814
Name:SURGEONS BEST ASSISTANT IN TEXAS
Entity Type:Organization
Organization Name:SURGEONS BEST ASSISTANT IN TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:MODARESI
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-368-2200
Mailing Address - Street 1:4815 JESSICA CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5444
Mailing Address - Country:US
Mailing Address - Phone:832-368-2200
Mailing Address - Fax:
Practice Address - Street 1:4815 JESSICA CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5444
Practice Address - Country:US
Practice Address - Phone:832-368-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00285246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841416740Medicare PIN