Healthcare Provider Details

I. General information

NPI: 1780869107
Provider Name (Legal Business Name): PROFESSIONAL PERIOPERATIVE SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8104 BEAR CREEK DR
AUSTIN TX
78737-4401
US

IV. Provider business mailing address

8104 BEAR CREEK DR
AUSTIN TX
78737-4401
US

V. Phone/Fax

Practice location:
  • Phone: 512-680-3757
  • Fax: 512-301-4579
Mailing address:
  • Phone: 512-680-3757
  • Fax: 512-301-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number600566
License Number StateTX

VIII. Authorized Official

Name: MR. DOUGLAS BURNS
Title or Position: PRESIDENT
Credential: RNFA
Phone: 512-680-3757