Provider Demographics
NPI:1760928576
Name:117 SURGICAL ASSISTANTS, PLLC
Entity Type:Organization
Organization Name:117 SURGICAL ASSISTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-485-5100
Mailing Address - Street 1:8840 CYPRESS WATERS BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4621
Mailing Address - Country:US
Mailing Address - Phone:817-485-5100
Mailing Address - Fax:
Practice Address - Street 1:8840 CYPRESS WATERS BLVD STE 190
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4621
Practice Address - Country:US
Practice Address - Phone:817-485-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty