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General NPI Number Information
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NPI Number | 1366976235
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Entity Type | Organization
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Legal Business Name | AGILE SURGICAL ASSISTANTS, LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/29/2017
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Provider Practice Location Address
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Address Line | 8428 WHIPPOORWILL DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1996
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Country | US
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Telephone | 817-713-8905
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Fax | 817-394-1427
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Provider Business Mailing Address
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Address Line | 8428 WHIPPOORWILL DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1996
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Country | US
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Telephone | 817-713-8905
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Fax | 817-394-1427
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Authorized Official
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Title or Position | CHAIRMAN/CEO
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Name | SERGIO GILES
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Credential | LSA
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Telephone | 817-713-8905
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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 | SA00564
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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