Provider Demographics
NPI:1760009195
Name:TOMBALL SURGICAL ASSISTANT SERVICE LLC
Entity Type:Organization
Organization Name:TOMBALL SURGICAL ASSISTANT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:IVOR
Authorized Official - Last Name:MOSQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-493-3204
Mailing Address - Street 1:PO BOX 690171
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-0171
Mailing Address - Country:US
Mailing Address - Phone:832-493-3204
Mailing Address - Fax:
Practice Address - Street 1:18220 TOMBALL PKWY # 249
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty