Provider Demographics
NPI:1700157666
Name:SPINAL INTRAOPERATIVE ASSISTANTS LLC
Entity Type:Organization
Organization Name:SPINAL INTRAOPERATIVE ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JABERANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-850-1190
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE. 475A
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3560
Mailing Address - Country:US
Mailing Address - Phone:713-850-1190
Mailing Address - Fax:713-850-1327
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:STE. 475A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3560
Practice Address - Country:US
Practice Address - Phone:713-850-1190
Practice Address - Fax:713-850-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04515363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty