Provider Demographics
NPI:1215416300
Name:JORDAN OAK SURGERY ASSIST, PLLC
Entity Type:Organization
Organization Name:JORDAN OAK SURGERY ASSIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAMS NPI ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2800
Mailing Address - Street 1:10004 WURZBACH RD # 241
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2214
Mailing Address - Country:US
Mailing Address - Phone:210-714-7165
Mailing Address - Fax:
Practice Address - Street 1:10004 WURZBACH RD # 241
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2214
Practice Address - Country:US
Practice Address - Phone:210-714-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty