Provider Demographics
NPI:1104384858
Name:PRIMA SURGICAL ASSISTANTS, LLC
Entity Type:Organization
Organization Name:PRIMA SURGICAL ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CSA, LSA, CNOR
Authorized Official - Phone:281-827-2108
Mailing Address - Street 1:1415 LEIGH GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1884
Mailing Address - Country:US
Mailing Address - Phone:713-239-4649
Mailing Address - Fax:
Practice Address - Street 1:1415 LEIGH GARDENS DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1884
Practice Address - Country:US
Practice Address - Phone:713-239-4649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty