MEDICARE: SURGICAL AUXILIUM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant

General Provider Information

NPI Number	:	1427331917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL AUXILIUM LLC

Provider Business Mailing Address
First Line	:	7925 ADOBE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-4607
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	7925 ADOBE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-4607
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY DURBIN
Credential	:
Telephone Number	:	214-227-2457

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	08/23/2016

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Directions to “SURGICAL AUXILIUM LLC ” Practice Location

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