Basic Information
Provider Information
NPI: 1821693201
EntityType: 2
ReplacementNPI:  
OrganizationName: MEEO SURGICAL ASSISTING LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: PO BOX 2550
Address2:  
City: ROWLETT
State: TX
PostalCode: 750302550
CountryCode: US
TelephoneNumber: 2142272457
FaxNumber: 2147640880
Practice Location
Address1: 2119 PACIFIC LOON LN
Address2:  
City: CONROE
State: TX
PostalCode: 773853029
CountryCode: US
TelephoneNumber: 2142272457
FaxNumber: 2147640880
Other Information
ProviderEnumerationDate: 12/02/2020
LastUpdateDate: 12/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: OGBAC
AuthorizedOfficialFirstName: MARK
AuthorizedOfficialMiddleName: E
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 9365258259
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: CSFA
NPICertificationDate: 12/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246ZC0007X  Y193400000X SINGLE SPECIALTY GROUPTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherCertified First Assistant

No ID Information.


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