Provider Demographics
NPI:1699005793
Name:SURG-ASIST PC
Entity Type:Organization
Organization Name:SURG-ASIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JANA BITTICK RNFA
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BITTICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-456-7754
Mailing Address - Street 1:1286 COUNTY ROAD 2788
Mailing Address - Street 2:
Mailing Address - City:ALVORD
Mailing Address - State:TX
Mailing Address - Zip Code:76225-3355
Mailing Address - Country:US
Mailing Address - Phone:817-456-7754
Mailing Address - Fax:
Practice Address - Street 1:1286 COUNTY ROAD 2788
Practice Address - Street 2:
Practice Address - City:ALVORD
Practice Address - State:TX
Practice Address - Zip Code:76225-3355
Practice Address - Country:US
Practice Address - Phone:817-456-7754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX524764163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty