Provider Demographics
NPI:1366647448
Name:SURGICAL ASSISTANTS OF GREATER HOUSTON
Entity Type:Organization
Organization Name:SURGICAL ASSISTANTS OF GREATER HOUSTON
Other - Org Name:SURGICAL ASSISTANTS OF GREATER HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:OPA-C, CSFA-OS
Authorized Official - Phone:512-697-9816
Mailing Address - Street 1:8104 EPHRAIM RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5334
Mailing Address - Country:US
Mailing Address - Phone:512-697-9816
Mailing Address - Fax:512-828-6486
Practice Address - Street 1:8104 EPHRAIM RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5334
Practice Address - Country:US
Practice Address - Phone:512-697-9816
Practice Address - Fax:512-828-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103402246ZC0007X
TX604363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103402OtherCERTIFIED SURGICAL FIRST ASSISTANT
00F703OtherCERTIFIED FIRST ASSISTANT
103402OtherORTHOPEDIC SPECIALIST
TX604OtherORTHOPEDIC P.A. CERT #