Healthcare Provider Details

I. General information

NPI: 1346793031
Provider Name (Legal Business Name): SLM SURGICAL ASSISTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 SERENE OAK DR
SUGAR LAND TX
77478-4431
US

IV. Provider business mailing address

PO BOX 1651
CROSBY TX
77532-1651
US

V. Phone/Fax

Practice location:
  • Phone: 346-221-1597
  • Fax: 832-581-4677
Mailing address:
  • Phone: 346-221-1597
  • Fax: 888-832-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00438
License Number StateTX

VIII. Authorized Official

Name: SHONDA MARTIN
Title or Position: OWNER
Credential: LSA
Phone: 346-221-1597