MEDICARE: CSM SURGICAL ASSISTANTS OF HOUSTON

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	SA00216	TX

General Provider Information

NPI Number	:	1891200804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSM SURGICAL ASSISTANTS OF HOUSTON

Provider Business Mailing Address
First Line	:	4114 CANDLEWOOD LN
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-5604
Country	:	US
Telephone Number	:	713-806-4065
Fax Number	:	281-489-4577

Provider Business Practice Location Address
First Line	:	4114 CANDLEWOOD LN
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-5604
Country	:	US
Telephone Number	:	713-806-4065
Fax Number	:	281-489-4577

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD MARSH
Credential	:	LSA
Telephone Number	:	713-806-4065

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	12/13/2017

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