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General NPI Number Information
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NPI Number | 1093254971
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Entity Type | Organization
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Legal Business Name | SCRUBX SURGICAL FIRST ASSISTING LLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 1307 AUTUMN MOON
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City | SAN ANTONIO
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State | TX
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Zip | 78245
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Country | US
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Telephone | 210-725-8783
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 AUTUMN MOON
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City | SAN ANTONIO
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State | TX
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Zip | 78245-1378
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Country | US
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Telephone | 210-725-8783
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Fax |
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Authorized Official
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Title or Position | CEO/SURGICAL FIRST ASSIST
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Name | MR. CLYDE KENNETH HARVEY JR.
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Credential | CST/ CSA
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Telephone | 210-725-8783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 4195
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License Number State | TX
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