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General NPI Number Information
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NPI Number | 1376670497
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Entity Type | Organization
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Legal Business Name | SURGICAL FIRST ASSISTANT SERVICES INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6226 INEZ AVE
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City | ORANGE
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State | TX
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Zip | 77630-7698
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Country | US
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Telephone | 409-735-7493
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Fax | 409-697-1104
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Provider Business Mailing Address
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Address Line | 6226 INEZ AVE
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City | ORANGE
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State | TX
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Zip | 77630-7698
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Country | US
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Telephone | 409-735-7493
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Fax | 409-697-1104
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIRK E PRUITT
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Credential | LSA
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Telephone | 409-735-7493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | SA00048
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License Number State | TX
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