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NPI Code Detail

MEDICARE: OLTON SURGICAL SERVICES, LLC

MEDICARE: OLTON SURGICAL SERVICES, 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
1225700000XMassage Therapist
2246ZC0007XSurgical Assistant
3363AS0400XSurgical Physician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100P07UOTHERTXBCBS - OLTON SURGICAL SERVICES, LLC
2SA00606OTHERTXSURGICAL ASSISTANT'S LICENSE

General Provider Information

NPI Number : 1912353905
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLTON SURGICAL SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 541602
Second Line :
City : HOUSTON
State : TX
Zip : 77254-1602
Country : US
Telephone Number : 832-523-3066
Fax Number : 832-602-2638
Provider Business Practice Location Address
First Line : 3375 WESTPARK DR
Second Line : UNIT 442
City : HOUSTON
State : TX
Zip : 77005-4262
Country : US
Telephone Number : 832-523-3066
Fax Number : 832-602-2638
Authorized Official
Title or Position : LICENSED SURGICAL ASSISTANT
Name : KATHYANN CYNTHELESE BRYANT
Credential : LSA
Telephone Number : 832-523-3066
Provider Enumeration Date : 05/09/2016
Last Update Date : 10/13/2020

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Directions to “OLTON SURGICAL SERVICES, LLC ” Practice Location

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