Provider Demographics
NPI:1164890018
Name:HOUSER SURGICAL ASSISTANTS
Entity Type:Organization
Organization Name:HOUSER SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAROD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:SR
Authorized Official - Credentials:CSFA
Authorized Official - Phone:404-312-7993
Mailing Address - Street 1:1715 POLO LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6193
Mailing Address - Country:US
Mailing Address - Phone:404-312-7993
Mailing Address - Fax:
Practice Address - Street 1:1715 POLO LAKE DR E
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6193
Practice Address - Country:US
Practice Address - Phone:404-312-7993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL149044246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty