Provider Demographics
NPI:1831690437
Name:FERCAMSA, LLC
Entity type:Organization
Organization Name:FERCAMSA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOVERDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-421-7828
Mailing Address - Street 1:12009 WHITTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4908
Mailing Address - Country:US
Mailing Address - Phone:832-421-7828
Mailing Address - Fax:
Practice Address - Street 1:12009 WHITTINGTON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4908
Practice Address - Country:US
Practice Address - Phone:832-421-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty