Healthcare Provider Details

I. General information

NPI: 1952772535
Provider Name (Legal Business Name): NATIONAL SURGICALSTAFF HEALTH PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MONKEY RD
ELGIN TX
78621-5506
US

IV. Provider business mailing address

236 MONKEY RD
ELGIN TX
78621-5506
US

V. Phone/Fax

Practice location:
  • Phone: 432-935-1755
  • Fax: 512-285-4776
Mailing address:
  • Phone: 432-935-1755
  • Fax: 512-285-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00074
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00074
License Number StateTX

VIII. Authorized Official

Name: DR. JEROLD STEPHEN GREER
Title or Position: OWNER
Credential: PHD LSA OPA-C
Phone: 432-935-1755