Healthcare Provider Details

I. General information

NPI: 1649796558
Provider Name (Legal Business Name): SMOOTH SURGICAL STAFFING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 EL DORADO 1507
WEBSTER TX
77598
US

IV. Provider business mailing address

PO BOX 20603
HOUSTON TX
77225-0603
US

V. Phone/Fax

Practice location:
  • Phone: 832-330-1508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY LEE HARDIN JR.
Title or Position: CEO
Credential: CSFA
Phone: 832-330-1508