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General NPI Number Information
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NPI Number | 1568977999
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Entity Type | Organization
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Legal Business Name | SANSOME SURGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 2600 E SOUTHLAKE BLVD STE 120 313
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8045
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Country | US
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Telephone | 214-612-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHLAKE BLVD STE 120 313
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8045
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Country | US
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Telephone | 214-612-6515
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Fax |
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Authorized Official
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Title or Position | MDMS NPI COMPLIANCE OFFICER
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Name | LIZETTE MORIN
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Credential |
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Telephone | 210-598-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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