Provider Demographics
NPI:1124263405
Name:CAPSTONE SURGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:CAPSTONE SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA, CNOR, BSN
Authorized Official - Phone:936-524-7317
Mailing Address - Street 1:2257 N LOOP 336 W
Mailing Address - Street 2:SUITE 140-407
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3520
Mailing Address - Country:US
Mailing Address - Phone:936-524-7317
Mailing Address - Fax:936-788-5659
Practice Address - Street 1:2257 N LOOP 336 W
Practice Address - Street 2:SUITE 140-407
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3520
Practice Address - Country:US
Practice Address - Phone:936-524-7317
Practice Address - Fax:936-788-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680131163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty