1609047802 NPI number — SURGICAL ADVANCED SPECIALTY CENTER LL LTD., L.L.P.

Table of content: MICHAEL JOHN VANDLIK DMD (NPI 1518941822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609047802 NPI number — SURGICAL ADVANCED SPECIALTY CENTER LL LTD., L.L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ADVANCED SPECIALTY CENTER LL LTD., L.L.P.
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:
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:
1609047802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 SCHOOL ST
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
TOMBALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77375-4595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-351-5409
Provider Business Mailing Address Fax Number:
281-351-2803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SCHOOL ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-4595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-351-5409
Provider Business Practice Location Address Fax Number:
281-351-2803
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARKINS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
281-351-5409

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  K2483 , 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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