Healthcare Provider Details

I. General information

NPI: 1891172805
Provider Name (Legal Business Name): SURGEXCEL FIRST ASSISTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 WONDER WORLD DR
SAN MARCOS TX
78666-7533
US

IV. Provider business mailing address

10001 S 1ST ST APT 635
AUSTIN TX
78748-6697
US

V. Phone/Fax

Practice location:
  • Phone: 512-938-2664
  • Fax:
Mailing address:
  • Phone: 979-240-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: EVERRET WILLIAMS
Title or Position: OWNER
Credential:
Phone: 979-240-4118