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General NPI Number Information
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NPI Number | 1699154716
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Entity Type | Organization
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Legal Business Name | CS SURGICAL PLLC
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 2200 PARK BEND DR STE 2-201
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City | AUSTIN
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State | TX
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Zip | 78758-5387
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Country | US
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Telephone | 512-835-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PARK BEND DR STE 2-201
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City | AUSTIN
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State | TX
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Zip | 78758-5387
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Country | US
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Telephone | 512-835-8100
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | RICHARD STOVALL
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Credential | MD
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Telephone | 512-835-8100
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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 | PA09247
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License Number State | TX
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