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General NPI Number Information
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NPI Number | 1891200804
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Entity Type | Organization
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Legal Business Name | CSM SURGICAL ASSISTANTS OF HOUSTON
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 4114 CANDLEWOOD LN
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City | MANVEL
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State | TX
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Zip | 77578-5604
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Country | US
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Telephone | 713-806-4065
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Fax | 281-489-4577
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Provider Business Mailing Address
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Address Line | 4114 CANDLEWOOD LN
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City | MANVEL
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State | TX
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Zip | 77578-5604
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Country | US
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Telephone | 713-806-4065
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Fax | 281-489-4577
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Authorized Official
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Title or Position | OWNER
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Name | RONALD MARSH
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Credential | LSA
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Telephone | 713-806-4065
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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 | SA00216
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License Number State | TX
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