Provider Demographics
NPI:1467807479
Name:SCOOBY'S SURGICAL ASSITING, PLLC
Entity Type:Organization
Organization Name:SCOOBY'S SURGICAL ASSITING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-564-7519
Mailing Address - Street 1:6 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5998
Mailing Address - Country:US
Mailing Address - Phone:214-564-7519
Mailing Address - Fax:
Practice Address - Street 1:6 WIMBLEDON CT
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-5998
Practice Address - Country:US
Practice Address - Phone:214-564-7519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577758163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty