Provider Demographics
NPI:1225252737
Name:FOUNDATION ANCILLARY SERVICES AFFILIATES, LLC
Entity Type:Organization
Organization Name:FOUNDATION ANCILLARY SERVICES AFFILIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:VICTORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-581-6950
Mailing Address - Street 1:PO BOX 3108
Mailing Address - Street 2:DEPT 902
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3108
Mailing Address - Country:US
Mailing Address - Phone:713-581-6950
Mailing Address - Fax:713-581-6951
Practice Address - Street 1:5420 WEST LOOP S
Practice Address - Street 2:SUITE 3100
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2107
Practice Address - Country:US
Practice Address - Phone:713-581-6950
Practice Address - Fax:713-581-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty