Provider Demographics
NPI:1932427861
Name:SURGIPAC SERVICES LLC
Entity Type:Organization
Organization Name:SURGIPAC SERVICES LLC
Other - Org Name:SURGIPAC SURGICAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:713-854-6467
Mailing Address - Street 1:22136 WESTHEIMER PKWY
Mailing Address - Street 2:#758
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8296
Mailing Address - Country:US
Mailing Address - Phone:713-854-6467
Mailing Address - Fax:888-826-7916
Practice Address - Street 1:22136 WESTHEIMER PKWY
Practice Address - Street 2:#758
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8296
Practice Address - Country:US
Practice Address - Phone:713-854-6467
Practice Address - Fax:281-954-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA00915363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty