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General NPI Number Information
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NPI Number | 1053648543
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Entity Type | Organization
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Legal Business Name | CENTRAL SURGICAL SUPPORT, LLC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 4501 CARTWRIGHT RD SUITE 606
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City | MISSOURI CITY
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State | TX
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Zip | 77459-3541
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Country | US
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Telephone | 281-969-7137
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Fax | 281-969-8882
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Provider Business Mailing Address
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Address Line | PO BOX 17054
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City | SUGAR LAND
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State | TX
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Zip | 77496-7054
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Country | US
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Telephone | 281-969-7137
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Fax | 281-969-8882
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AMANDA WOOD
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Credential | RN
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Telephone | 281-969-7137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 000000000
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License Number State | TX
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