1013386549 NPI number — OLYMPIA SURGICAL ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013386549 NPI number — OLYMPIA SURGICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIA SURGICAL ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013386549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13525 CENTERBROOK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIVERSAL CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78148-2734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-257-8014
Provider Business Mailing Address Fax Number:
210-257-6856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13525 CENTERBROOK
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
UNIVERSAL CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78148-2734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-257-8014
Provider Business Practice Location Address Fax Number:
210-257-6856
Provider Enumeration Date:
09/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SILVESTER
Authorized Official First Name:
MARILEE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASC ADMINISTRATOR
Authorized Official Telephone Number:
210-257-8014

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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