Healthcare Provider Details

I. General information

NPI: 1588002653
Provider Name (Legal Business Name): SR SURGICAL ASSISTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 W ROYAL LN STE 196
IRVING TX
75063-1959
US

IV. Provider business mailing address

PO BOX 268938
OKLAHOMA CITY OK
73126-8938
US

V. Phone/Fax

Practice location:
  • Phone: 817-485-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES C NEFF
Title or Position: DIRECTOR
Credential:
Phone: 817-485-5100