=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699294751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WB ASSISTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2017
-----------------------------------------------------
Last Update Date | 09/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4427 N VINEYARD MEADOW LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-3445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-248-8635
-----------------------------------------------------
Fax | 832-248-8635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4427 N VINEYARD MEADOW LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-3445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-248-8635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. TIMOTHY WAYNE ROBERTSON JR.
-----------------------------------------------------
Credential | LSA, CSA
-----------------------------------------------------
Telephone | 281-900-3144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | SA00487
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------