Provider Demographics
NPI:1093254971
Name:SCRUBX SURGICAL FIRST ASSISTING LLC
Entity Type:Organization
Organization Name:SCRUBX SURGICAL FIRST ASSISTING LLC
Other - Org Name:SCRUBX SURGICAL FIRST ASSISTING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/SURGICAL FIRST ASSIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:CST/ CSA
Authorized Official - Phone:210-725-8783
Mailing Address - Street 1:1307 AUTUMN MOON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1378
Mailing Address - Country:US
Mailing Address - Phone:210-725-8783
Mailing Address - Fax:
Practice Address - Street 1:1307 AUTUMN MOON
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245
Practice Address - Country:US
Practice Address - Phone:210-725-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4195246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty