Provider Demographics
NPI:1750640702
Name:J.R. SURGICAL ASSISTANT GROUP INC.
Entity Type:Organization
Organization Name:J.R. SURGICAL ASSISTANT GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LSA, CSA, OPAC
Authorized Official - Phone:281-830-4845
Mailing Address - Street 1:3022 NORWICH ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2322
Mailing Address - Country:US
Mailing Address - Phone:281-830-4845
Mailing Address - Fax:713-436-1295
Practice Address - Street 1:3022 NORWICH ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2322
Practice Address - Country:US
Practice Address - Phone:281-830-4845
Practice Address - Fax:713-436-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00427363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty