Provider Demographics
NPI:1376882506
Name:INNOVATIVE SURGICAL AFFILIATE
Entity Type:Organization
Organization Name:INNOVATIVE SURGICAL AFFILIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SA-C/ SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-390-1082
Mailing Address - Street 1:3810 LAW # 234
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1171
Mailing Address - Country:US
Mailing Address - Phone:832-390-1082
Mailing Address - Fax:832-610-3690
Practice Address - Street 1:3810 LAW # 234
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1171
Practice Address - Country:US
Practice Address - Phone:832-390-1082
Practice Address - Fax:832-610-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11-100246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty