Healthcare Provider Details

I. General information

NPI: 1902325459
Provider Name (Legal Business Name): TEXTUS & OSSIS SURGICAL ASSISTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 GRANTS MILL RUN
DACULA GA
30019-5425
US

IV. Provider business mailing address

PO BOX 2550
ROWLETT TX
75030-2550
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number168130
License Number StateGA

VIII. Authorized Official

Name: NHORA SANTIAGO-GAMBOA
Title or Position: SURGICAL FIRST ASSISTANT
Credential: CSFA
Phone: 404-909-7195