Provider Demographics
NPI:1306196373
Name:CORE SURGICAL SUPPORT, LLC
Entity Type:Organization
Organization Name:CORE SURGICAL SUPPORT, 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
Authorized Official - Phone:281-969-7137
Mailing Address - Street 1:PO BOX 18821
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-8821
Mailing Address - Country:US
Mailing Address - Phone:281-969-7137
Mailing Address - Fax:281-969-8882
Practice Address - Street 1:4501 CARTWRIGHT RD
Practice Address - Street 2:SUITE 606
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3541
Practice Address - Country:US
Practice Address - Phone:281-969-7137
Practice Address - Fax:281-969-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty