MEDICARE: KEY SURGICAL ASSISTANTS OF TEXAS LP

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	174400000X	Specialist		TX

General Provider Information

NPI Number	:	1770648289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEY SURGICAL ASSISTANTS OF TEXAS LP

Provider Business Mailing Address
First Line	:	1860 FM 359 RD # 227
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-1296
Country	:	US
Telephone Number	:	713-777-4539
Fax Number	:	713-777-4542

Provider Business Practice Location Address
First Line	:	9494 SOUTHWEST FWY
Second Line	:	SUITE 620
City	:	HOUSTON
State	:	TX
Zip	:	77074-1419
Country	:	US
Telephone Number	:	713-777-4539
Fax Number	:	713-777-4542

Authorized Official
Title or Position	:	CFO DIRECTOR OF OPERATIONS
Name	:	MR. MICHAEL WAYNE HERNANDEZ
Credential	:
Telephone Number	:	713-777-4539

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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