MEDICARE: ARDEMAIK SURGICAL SERVICES

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	SA00445	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA00445	OTHER	TX	TEXAS MEDICAL BOARD

General Provider Information

NPI Number	:	1831580166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDEMAIK SURGICAL SERVICES

Provider Business Mailing Address
First Line	:	10935 ALMEDA GENOA RD
Second Line	:	P.O. BOX 34551
City	:	HOUSTON
State	:	TX
Zip	:	77034-9998
Country	:	US
Telephone Number	:	281-653-2924
Fax Number	:

Provider Business Practice Location Address
First Line	:	10935 ALMEDA GENOA RD
Second Line	:	POB 34551
City	:	HOUSTON
State	:	TX
Zip	:	77034-9998
Country	:	US
Telephone Number	:	281-653-2924
Fax Number	:

Authorized Official
Title or Position	:	SURGICAL ASSISTANT
Name	:	ELSIDA MARGARITA PEREZ TAMAYO
Credential	:
Telephone Number	:	281-653-2924

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/09/2015

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Directions to “ARDEMAIK SURGICAL SERVICES ” Practice Location

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