Provider Demographics
NPI:1386233807
Name:P & D SURGICALLY ASSIST PLLC
Entity type:Organization
Organization Name:P & D SURGICALLY ASSIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPI ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-756-8232
Mailing Address - Street 1:2140 HALL JOHNSON RD, 102 #108
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5128
Practice Address - Country:US
Practice Address - Phone:817-756-8236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty