Healthcare Provider Details

I. General information

NPI: 1144760208
Provider Name (Legal Business Name): NEWBURY SURGICAL STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10223 BROADWAY ST SUITE P-284
PEARLAND TX
77584-7880
US

IV. Provider business mailing address

10223 BROADWAY ST SUITE P-284
PEARLAND TX
77584-7880
US

V. Phone/Fax

Practice location:
  • Phone: 832-872-3794
  • Fax:
Mailing address:
  • Phone: 832-872-3794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: DERICK COWANS
Title or Position: COO
Credential: CSFA
Phone: 832-872-3794