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NPI Code Detail

MEDICARE: RYAN SURGICAL ASSIST LLC

MEDICARE: RYAN SURGICAL ASSIST 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
1163WR0006XRegistered Nurse First Assistant

General Provider Information

NPI Number : 1922352541
Entity Type Code : Organization
Provider Name (Legal Business Name) : RYAN SURGICAL ASSIST LLC
Provider Business Mailing Address
First Line : 3118 QUENBY AVE
Second Line :
City : HOUSTON
State : TX
Zip : 77005-2338
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3118 QUENBY AVE
Second Line :
City : HOUSTON
State : TX
Zip : 77005-2338
Country : US
Telephone Number : 281-463-6309
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MRS. KERRY INCAVO
Credential :
Telephone Number : 281-463-6309
Provider Enumeration Date : 11/05/2012
Last Update Date : 08/19/2014

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Directions to “RYAN SURGICAL ASSIST LLC ” Practice Location

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