Healthcare Provider Details

I. General information

NPI: 1891049748
Provider Name (Legal Business Name): PARAMOUNT SURGICAL ASSISTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 LICHEN LN
SPRING TX
77379-4517
US

IV. Provider business mailing address

8215 LICHEN LN
SPRING TX
77379-4517
US

V. Phone/Fax

Practice location:
  • Phone: 832-559-3870
  • Fax: 270-778-3909
Mailing address:
  • Phone: 832-559-3870
  • Fax: 270-778-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00319
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL B A RILEY
Title or Position: LICENSED SURGICAL ASSISTANT
Credential: LSA / CSA
Phone: 832-559-3870