Healthcare Provider Details

I. General information

NPI: 1699005793
Provider Name (Legal Business Name): SURG-ASIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 COUNTY ROAD 2788
ALVORD TX
76225-3355
US

IV. Provider business mailing address

1286 COUNTY ROAD 2788
ALVORD TX
76225-3355
US

V. Phone/Fax

Practice location:
  • Phone: 817-456-7754
  • Fax:
Mailing address:
  • Phone: 817-456-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number524764
License Number StateTX

VIII. Authorized Official

Name: JANA DENISE BITTICK
Title or Position: JANA BITTICK RNFA
Credential:
Phone: 817-456-7754