Healthcare Provider Details

I. General information

NPI: 1790130839
Provider Name (Legal Business Name): SYNERGOS SURGICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 LOWELL CT
KATY TX
77494-6100
US

IV. Provider business mailing address

PO BOX 9879
SPRING TX
77387-6879
US

V. Phone/Fax

Practice location:
  • Phone: 281-820-1900
  • Fax: 281-820-1901
Mailing address:
  • Phone: 281-820-1900
  • Fax: 281-820-1901

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: ORAN HARTWELL
Title or Position: OPERATING MANAGER
Credential:
Phone: 281-820-1900