MEDICARE: PA SURGICAL SERVICES INC

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	363A00000X	Physician Assistant	PA02366	TX

General Provider Information

NPI Number	:	1881860948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PA SURGICAL SERVICES INC

Provider Business Mailing Address
First Line	:	1141 N LOOP 1604 E #105-612
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232
Country	:	US
Telephone Number	:	210-598-4262
Fax Number	:

Provider Business Practice Location Address
First Line	:	15315 POPLAR SPRINGS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-3670
Country	:	US
Telephone Number	:	210-598-4262
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLIENT EXPERIENCE
Name	:	ROXANNA LAROQUE
Credential	:
Telephone Number	:	210-598-4262

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	07/19/2022

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