Provider Demographics
NPI:1871022251
Name:LONDON SURGICAL SERVICES,LLC
Entity Type:Organization
Organization Name:LONDON SURGICAL SERVICES,LLC
Other - Org Name:LONDON SURGICAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LEANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASCO-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:281-620-4242
Mailing Address - Street 1:27942 MADISON BEND DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4408
Mailing Address - Country:US
Mailing Address - Phone:281-620-4242
Mailing Address - Fax:
Practice Address - Street 1:27942 MADISON BEND DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4408
Practice Address - Country:US
Practice Address - Phone:281-620-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00406363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty