Provider Demographics
NPI:1659601805
Name:SURGICAL SPECIALTY ASSOCIATES
Entity Type:Organization
Organization Name:SURGICAL SPECIALTY ASSOCIATES
Other - Org Name:SURGICAL SPECIALTY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:281-798-6695
Mailing Address - Street 1:17534 SANDY CLIFFS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2064
Mailing Address - Country:US
Mailing Address - Phone:281-798-6695
Mailing Address - Fax:
Practice Address - Street 1:17534 SANDY CLIFFS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2064
Practice Address - Country:US
Practice Address - Phone:281-798-6695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXSA0110363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty