Provider Demographics
NPI:1013348366
Name:RUSHMORE SURGICAL ASSISTANTS LLC
Entity Type:Organization
Organization Name:RUSHMORE SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:YARRITO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LSA
Authorized Official - Phone:936-760-6591
Mailing Address - Street 1:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-0018
Mailing Address - Country:US
Mailing Address - Phone:936-760-6591
Mailing Address - Fax:936-582-6013
Practice Address - Street 1:17400 ST LUKES WAY
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8036
Practice Address - Country:US
Practice Address - Phone:936-760-6591
Practice Address - Fax:936-582-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00395246ZC0007X
TX3341246ZC0007X
TX548445246ZS0410X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty