Provider Demographics
NPI:1023594264
Name:LOYAL CROWN ASSISTING
Entity type:Organization
Organization Name:LOYAL CROWN ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:SOTHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-704-0932
Mailing Address - Street 1:3300 FALCON LANDING BLVD APT 7104
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7767
Mailing Address - Country:US
Mailing Address - Phone:281-704-0932
Mailing Address - Fax:
Practice Address - Street 1:3300 FALCON LANDING BLVD APT 7104
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7767
Practice Address - Country:US
Practice Address - Phone:281-704-0932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty