Provider Demographics
NPI:1124430608
Name:FRONT LINE SURGICAL ASSISTANTS INC
Entity type:Organization
Organization Name:FRONT LINE SURGICAL ASSISTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARGOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-426-3023
Mailing Address - Street 1:21216 NORTHWEST FWY STE 250
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4778
Mailing Address - Country:US
Mailing Address - Phone:713-426-3023
Mailing Address - Fax:
Practice Address - Street 1:21216 NORTHWEST FWY STE 250
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4778
Practice Address - Country:US
Practice Address - Phone:713-426-3023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherBCBS