Provider Demographics
NPI:1871854034
Name:MEDSURGICAL GROUP LLC
Entity Type:Organization
Organization Name:MEDSURGICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANRIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-463-6309
Mailing Address - Street 1:PO BOX 301731
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1731
Mailing Address - Country:US
Mailing Address - Phone:281-463-6309
Mailing Address - Fax:
Practice Address - Street 1:2131 HAROLD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1401
Practice Address - Country:US
Practice Address - Phone:281-463-6309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty