Provider Demographics
NPI:1538609367
Name:PERIOP SURGICAL ALLIANCE SOUTHWEST LLC
Entity type:Organization
Organization Name:PERIOP SURGICAL ALLIANCE SOUTHWEST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:YARRITO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LSA
Authorized Official - Phone:936-760-6591
Mailing Address - Street 1:2300 WOODFOREST PKWY N STE 250-162
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-6501
Mailing Address - Country:US
Mailing Address - Phone:936-760-6591
Mailing Address - Fax:936-582-6013
Practice Address - Street 1:17200 ST LUKES WAY
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8007
Practice Address - Country:US
Practice Address - Phone:936-760-6591
Practice Address - Fax:936-582-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00395246ZC0007X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty