Healthcare Provider Details

I. General information

NPI: 1386996155
Provider Name (Legal Business Name): TSL SURGICAL ASSISTANT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 06/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 SUMMIT LODGE DR
KATY TX
77449-6033
US

IV. Provider business mailing address

PO BOX 5331
KATY TX
77491-5331
US

V. Phone/Fax

Practice location:
  • Phone: 281-653-2924
  • Fax: 281-254-7923
Mailing address:
  • Phone: 281-653-2924
  • Fax: 281-254-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. MANUEL RODRIGUEZ
Title or Position: SURGICAL FIRST ASSISTANT
Credential: CSA
Phone: 281-653-2924