Healthcare Provider Details

I. General information

NPI: 1053648543
Provider Name (Legal Business Name): CENTRAL SURGICAL SUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 CARTWRIGHT RD SUITE 606
MISSOURI CITY TX
77459-3541
US

IV. Provider business mailing address

PO BOX 17054
SUGAR LAND TX
77496-7054
US

V. Phone/Fax

Practice location:
  • Phone: 281-969-7137
  • Fax: 281-969-8882
Mailing address:
  • Phone: 281-969-7137
  • Fax: 281-969-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number000000000
License Number StateTX

VIII. Authorized Official

Name: MS. AMANDA WOOD
Title or Position: PRESIDENT
Credential: RN
Phone: 281-969-7137