Provider Demographics
NPI:1295152247
Name:KNOWLEDGEABLE HANDS SURGICAL SERVICES, LLC
Entity type:Organization
Organization Name:KNOWLEDGEABLE HANDS SURGICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA, RN, SA-C
Authorized Official - Phone:409-457-3796
Mailing Address - Street 1:2323 CLEAR LAKE CITY BLVD
Mailing Address - Street 2:SUITE#180-187
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8120
Mailing Address - Country:US
Mailing Address - Phone:409-457-3796
Mailing Address - Fax:
Practice Address - Street 1:2323 CLEAR LAKE CITY BLVD
Practice Address - Street 2:SUITE#180-187
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8120
Practice Address - Country:US
Practice Address - Phone:409-457-3796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00339246ZC0007X, 363AS0400X, 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