Healthcare Provider Details

I. General information

NPI: 1831663228
Provider Name (Legal Business Name): STAT SURGICAL ASSISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16020 PARK VALLEY DR
ROUND ROCK TX
78681
US

IV. Provider business mailing address

MSC 708 PO BOX 4914
HOUSTON TX
77210-4914
US

V. Phone/Fax

Practice location:
  • Phone: 512-629-4329
  • Fax:
Mailing address:
  • Phone: 512-629-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: FELICIA ALDERTE
Title or Position: LEGAL OPERATIONS MANAGER
Credential:
Phone: 210-598-2801