Healthcare Provider Details

I. General information

NPI: 1396298469
Provider Name (Legal Business Name): WCK SURGICAL ASSISTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 NORWICH ST
PEARLAND TX
77584-2322
US

IV. Provider business mailing address

3022 NORWICH ST
PEARLAND TX
77584-2322
US

V. Phone/Fax

Practice location:
  • Phone: 281-830-4845
  • Fax: 713-436-1295
Mailing address:
  • Phone: 281-830-4845
  • Fax: 713-436-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00427
License Number StateTX

VIII. Authorized Official

Name: MR. WARREN LEE KEYS JR.
Title or Position: MANAGING PARTNER
Credential: LSA
Phone: 281-830-4845