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General NPI Number Information
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NPI Number | 1205363330
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Entity Type | Organization
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Legal Business Name | TEXAS PRINCIPAL SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 22999 HIGHWAY 59 N
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City | KINGWOOD
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State | TX
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Zip | 77339-4412
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Country | US
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Telephone | 713-575-0830
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Fax |
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Provider Business Mailing Address
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Address Line | 18538 WOLF CREEK TRL
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City | HUMBLE
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State | TX
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Zip | 77346-3041
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Country | US
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Telephone | 713-575-0830
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Fax |
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Authorized Official
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Title or Position | LICENSED SURGICAL ASSISTANT
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Name | MR. DARREN RAMON HEATH
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Credential | LSA
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Telephone | 713-575-0830
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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 | SA00594
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License Number State | TX
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