Provider Demographics
NPI:1316472939
Name:SKILLED SURGICAL SERVICES LLC
Entity type:Organization
Organization Name:SKILLED SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:281-653-2924
Mailing Address - Street 1:PO BOX 2071
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-2071
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:17514 STONEBROOK RUN CT
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-0065
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:832-478-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00331363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00331OtherLICENSE SURGICAL ASSISTANT