Provider Demographics
NPI:1881873446
Name:AMHERST SURGICAL SPECIALISTS PA
Entity type:Organization
Organization Name:AMHERST SURGICAL SPECIALISTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-993-7124
Mailing Address - Street 1:3429 W HOLCOMBE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1311
Mailing Address - Country:US
Mailing Address - Phone:713-993-7124
Mailing Address - Fax:713-963-0476
Practice Address - Street 1:3429 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1311
Practice Address - Country:US
Practice Address - Phone:713-993-7124
Practice Address - Fax:713-963-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN156665502Medicaid
TX0032EZOtherBLUE CROSS BLUE SHIELD
TX00897TOtherMEDICARE
TX00897TMedicare PIN