Provider Demographics
NPI:1710405246
Name:PULSE SURGICAL LLC
Entity Type:Organization
Organization Name:PULSE SURGICAL LLC
Other - Org Name:PULSE SURGICAL LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKORUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:361-876-6689
Mailing Address - Street 1:5929 BRIGHTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3029
Mailing Address - Country:US
Mailing Address - Phone:361-537-3209
Mailing Address - Fax:
Practice Address - Street 1:5929 BRIGHTWOOD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3029
Practice Address - Country:US
Practice Address - Phone:361-537-3209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00374363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty