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General NPI Number Information
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NPI Number | 1467502849
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Entity Type | Organization
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Legal Business Name | UNITED SURGEON HEALTH MANAGEMENT CORP
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20023 SKY HOLLOW LN
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City | KATY
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State | TX
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Zip | 77450-5219
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Country | US
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Telephone | 832-452-6628
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Fax | 281-829-9149
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Provider Business Mailing Address
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Address Line | PO BOX 431125
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City | HOUSTON
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State | TX
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Zip | 77243-1125
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Country | US
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Telephone | 832-452-6628
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Fax | 281-829-9149
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BYSMARK ABRAHAM ACEBO
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Credential | L.S.A.
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Telephone | 281-829-0941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA0008
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License Number State | TX
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