Healthcare Provider Details

I. General information

NPI: 1982250007
Provider Name (Legal Business Name): MEDICUS SURGICAL ASSIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18302 NOYCE RD
CROSBY TX
77532-7807
US

IV. Provider business mailing address

PO BOX 150295
LAKEWOOD CO
80215-0295
US

V. Phone/Fax

Practice location:
  • Phone: 281-346-3480
  • Fax: 281-462-4106
Mailing address:
  • Phone: 281-346-3480
  • Fax: 281-462-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: RHONDA TURNER
Title or Position: OWNER
Credential:
Phone: 281-346-3480