Basic Information
| Provider Information | |||||||||
| NPI: | 1689236341 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUSTON ADVANCED SURGICAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 34388 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323226713 | ||||||||
| FaxNumber: | 7134850240 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W. MEDICAL CENTER BLVD. | ||||||||
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| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813322511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 07/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8323226713 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CST, CSFA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.