MEDICARE: SYNERGOS SURGICAL ASSOCIATES, PLLC

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1790130839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGOS SURGICAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 9879
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77387-6879
Country	:	US
Telephone Number	:	281-820-1900
Fax Number	:	281-820-1901

Provider Business Practice Location Address
First Line	:	1803 LOWELL CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6100
Country	:	US
Telephone Number	:	281-820-1900
Fax Number	:	281-820-1901

Authorized Official
Title or Position	:	OPERATING MANAGER
Name	:	ORAN HARTWELL
Credential	:
Telephone Number	:	281-820-1900

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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