MEDICARE: AMERICAN ORTHOPEDICS SURGICAL ASSIST, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1326913484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN ORTHOPEDICS SURGICAL ASSIST, LLC

Provider Business Mailing Address
First Line	:	1141 N LOOP 1604 E # 105-612
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1339
Country	:	US
Telephone Number	:	210-598-4268
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 ENTERPRISE BLVD STE 209
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3554
Country	:	US
Telephone Number	:	210-598-4268
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, CLIENT RELATIONS
Name	:	ROXANNA LAROQUE
Credential	:
Telephone Number	:	210-598-4268

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	12/08/2025

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