Provider Demographics
NPI:1609126911
Name:LINCOLN SURGICAL SUPPORT, LC
Entity Type:Organization
Organization Name:LINCOLN SURGICAL SUPPORT, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ESTUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-646-6110
Mailing Address - Street 1:1111 OLD OYSTER TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4537
Mailing Address - Country:US
Mailing Address - Phone:832-646-6110
Mailing Address - Fax:713-583-3047
Practice Address - Street 1:1111 OLD OYSTER TRL
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4537
Practice Address - Country:US
Practice Address - Phone:832-646-6110
Practice Address - Fax:713-583-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty