Healthcare Provider Details

I. General information

NPI: 1114110012
Provider Name (Legal Business Name): LISA R SAULSBERRY 1ST ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 HOSPITAL DR STE 280
BEAUMONT TX
77701-4663
US

IV. Provider business mailing address

740 HOSPITAL DR STE 280
BEAUMONT TX
77701-4663
US

V. Phone/Fax

Practice location:
  • Phone: 409-835-9500
  • Fax:
Mailing address:
  • Phone: 409-835-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number06-116
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: