Healthcare Provider Details

I. General information

NPI: 1437630498
Provider Name (Legal Business Name): S SQUARED ASSISTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 COUNTY ROAD 3355
PARADISE TX
76073-4661
US

IV. Provider business mailing address

PO BOX 2550
ROWLETT TX
75030-2550
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00688
License Number StateTX

VIII. Authorized Official

Name: MR. CHRISTOPHER J STEGMAN
Title or Position: OWNER
Credential: LSA
Phone: 214-396-7989