Provider Demographics
NPI:1932653300
Name:ALLY SURGICAL FIRST ASSIST.LLC
Entity Type:Organization
Organization Name:ALLY SURGICAL FIRST ASSIST.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:713-885-5885
Mailing Address - Street 1:1747 WROXTON CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1751
Mailing Address - Country:US
Mailing Address - Phone:713-885-5885
Mailing Address - Fax:713-721-2535
Practice Address - Street 1:1747 WROXTON CT SUITE 1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005
Practice Address - Country:US
Practice Address - Phone:713-885-5885
Practice Address - Fax:713-721-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613015163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty