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General NPI Number Information
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NPI Number | 1992970966
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Entity Type | Organization
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Legal Business Name | FIRST SOUTHWEST SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 5918 DEWDROP LN
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City | CONVERSE
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State | TX
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Zip | 78109-3741
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Country | US
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Telephone | 830-734-2689
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Fax | 210-475-3995
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Provider Business Mailing Address
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Address Line | 5819 DEWDROP LANE
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City | CONVERSE
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State | TX
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Zip | 78109-9787
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Country | US
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Telephone | 830-734-2689
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Fax | 210-475-3995
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Authorized Official
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Title or Position | SA-C
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Name | MR. SAMUEL B. HENDERSON SR.
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Credential | SA-C
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Telephone | 830-734-2689
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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 |
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License Number State |
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