Provider Demographics
NPI: | 1942974597 |
---|---|
Name: | SURGICAL SERVICES OF TEXAS PLLC |
Entity Type: | Organization |
Organization Name: | SURGICAL SERVICES OF TEXAS PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CALEB |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COLON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LSA |
Authorized Official - Phone: | 214-227-2457 |
Mailing Address - Street 1: | PO BOX 2550 |
Mailing Address - Street 2: | |
Mailing Address - City: | ROWLETT |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75030-2550 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 214-227-2457 |
Mailing Address - Fax: | 214-764-0880 |
Practice Address - Street 1: | 11936 RAVENVIEW RD |
Practice Address - Street 2: | |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75253-2923 |
Practice Address - Country: | US |
Practice Address - Phone: | 214-227-2457 |
Practice Address - Fax: | 214-764-0880 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-08-06 |
Last Update Date: | 2022-04-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 246ZC0007X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Surgical Assistant | Group - Single Specialty |