Healthcare Provider Details

I. General information

NPI: 1689236341
Provider Name (Legal Business Name): HOUSTON ADVANCED SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N LOOP 336 W STE 410-E
CONROE TX
77301-1193
US

IV. Provider business mailing address

1110 N LOOP 336 W STE 410-E
CONROE TX
77301-1193
US

V. Phone/Fax

Practice location:
  • Phone: 936-337-3565
  • Fax: 936-260-0265
Mailing address:
  • Phone: 936-337-3565
  • Fax: 936-260-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY M MITCHELL
Title or Position: LAB DIRECTOR
Credential: LSA, CSFA,CST
Phone: 832-322-6713