Provider Demographics
NPI:1508241837
Name:BC SURGEON HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:BC SURGEON HEALTHCARE CORPORATION
Other - Org Name:SAME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACEBO
Authorized Official - Suffix:SR
Authorized Official - Credentials:SURGEON ASISTANT
Authorized Official - Phone:832-713-9153
Mailing Address - Street 1:20023 SKY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5219
Mailing Address - Country:US
Mailing Address - Phone:832-713-9153
Mailing Address - Fax:
Practice Address - Street 1:20023 SKY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5219
Practice Address - Country:US
Practice Address - Phone:832-713-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00008246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherCERTIFIED FIRST ASISTANT