Provider Demographics
NPI:1912353905
Name:OLTON SURGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:OLTON SURGICAL SERVICES, LLC
Other - Org Name:OLTON SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHYANN
Authorized Official - Middle Name:CYNTHELESE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-523-3066
Mailing Address - Street 1:PO BOX 541602
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-1602
Mailing Address - Country:US
Mailing Address - Phone:832-523-3066
Mailing Address - Fax:832-602-2638
Practice Address - Street 1:3375 WESTPARK DR
Practice Address - Street 2:UNIT 442
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4262
Practice Address - Country:US
Practice Address - Phone:832-523-3066
Practice Address - Fax:832-602-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P07UOtherBCBS - OLTON SURGICAL SERVICES, LLC
TXSA00606OtherSURGICAL ASSISTANT'S LICENSE