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General NPI Number Information
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NPI Number | 1346767431
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Entity Type | Organization
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Legal Business Name | ELITE PA SURGICAL ASSISTS, PLLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2600 E SOUTHLAKE BLVD STE 120-177
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6634
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Country | US
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Telephone | 469-708-3989
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHLAKE BLVD STE 120-177
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6634
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Country | US
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Telephone | 469-708-3989
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAULINA PURNAMA
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Credential | PA-C
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Telephone | 469-708-3989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | TX11021
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License Number State | TX
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