Provider Demographics
NPI:1225236391
Name:SKS SURGICAL GROUP PA
Entity Type:Organization
Organization Name:SKS SURGICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-347-0088
Mailing Address - Street 1:23960 KATY FWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1339
Mailing Address - Country:US
Mailing Address - Phone:281-347-0088
Mailing Address - Fax:
Practice Address - Street 1:23960 KATY FWY
Practice Address - Street 2:SUITE 130
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1339
Practice Address - Country:US
Practice Address - Phone:281-347-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225236391Medicaid
TXI42130Medicare UPIN
00513ZMedicare PIN