Provider Demographics
NPI:1790179893
Name:247 OBGYN SURGICAL ASSISTING SERVICES
Entity type:Organization
Organization Name:247 OBGYN SURGICAL ASSISTING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUJUTALLI
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:972-652-0705
Mailing Address - Street 1:4924 MARSH HARRIER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3057
Mailing Address - Country:US
Mailing Address - Phone:972-652-0705
Mailing Address - Fax:972-752-7889
Practice Address - Street 1:4924 MARSH HARRIER AVE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3057
Practice Address - Country:US
Practice Address - Phone:972-652-0705
Practice Address - Fax:972-752-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty