Healthcare Provider Details

I. General information

NPI: 1043496557
Provider Name (Legal Business Name): FOUR HANDS SURGICAL ASSISTANT CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MCKINNEY ST
HOUSTON TX
77010-2011
US

IV. Provider business mailing address

PO BOX 588
SANTA FE TX
77510-0588
US

V. Phone/Fax

Practice location:
  • Phone: 713-442-4700
  • Fax:
Mailing address:
  • Phone: 409-925-0332
  • Fax: 409-925-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DIANA SIERK
Title or Position: PRESIDENT
Credential: BILLING AGENCY
Phone: 409-925-0332