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General NPI Number Information
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NPI Number | 1538609367
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Entity Type | Organization
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Legal Business Name | PERIOP SURGICAL ALLIANCE SOUTHWEST LLC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 17200 ST LUKES WAY
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City | THE WOODLANDS
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State | TX
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Zip | 77384-8007
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Country | US
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Telephone | 936-760-6591
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Fax | 936-582-6013
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Provider Business Mailing Address
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Address Line | 2300 WOODFOREST PKWY N STE 250-162
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City | MONTGOMERY
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State | TX
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Zip | 77316-6501
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Country | US
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Telephone | 936-760-6591
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Fax | 936-582-6013
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Authorized Official
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Title or Position | CEO
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Name | MR. ELIAS YARRITO JR.
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Credential | LSA
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Telephone | 936-760-6591
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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 | SA00395
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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