Provider Demographics
NPI:1104340058
Name:TEXAS PROFESSIONAL FIRST ASSISTANCE,LLC
Entity type:Organization
Organization Name:TEXAS PROFESSIONAL FIRST ASSISTANCE,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:512-557-6433
Mailing Address - Street 1:204 DEERCREEK LN
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-7819
Mailing Address - Country:US
Mailing Address - Phone:512-557-6433
Mailing Address - Fax:
Practice Address - Street 1:204 DEERCREEK LN
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-7819
Practice Address - Country:US
Practice Address - Phone:512-557-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87458246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty