Healthcare Provider Details

I. General information

NPI: 1740535012
Provider Name (Legal Business Name): PREVITY SURGICAL ASSISTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
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 Number
License Number State

VIII. Authorized Official

Name: PATRICIA HALL
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 409-835-9500