Provider Demographics
NPI:1710014048
Name:SEGUIN SURGICAL SERVICES PA
Entity Type:Organization
Organization Name:SEGUIN SURGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-372-2840
Mailing Address - Street 1:1255 ASHBY
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155
Mailing Address - Country:US
Mailing Address - Phone:830-372-2840
Mailing Address - Fax:830-372-2547
Practice Address - Street 1:1255 ASHBY
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-372-2840
Practice Address - Fax:830-372-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7589208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B87649Medicare UPIN
TX00HM96Medicare ID - Type Unspecified