Provider Demographics
NPI:1366976235
Name:AGILE SURGICAL ASSISTANTS, LLC
Entity type:Organization
Organization Name:AGILE SURGICAL ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:817-713-8905
Mailing Address - Street 1:8428 WHIPPOORWILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1996
Mailing Address - Country:US
Mailing Address - Phone:817-713-8905
Mailing Address - Fax:817-394-1427
Practice Address - Street 1:8428 WHIPPOORWILL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1996
Practice Address - Country:US
Practice Address - Phone:817-713-8905
Practice Address - Fax:817-394-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00564246ZC0007X
363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty