Provider Demographics
NPI:1922384072
Name:MICHAEL A. ELLER SURGICAL ASSISTANT SERVICES, LLC
Entity type:Organization
Organization Name:MICHAEL A. ELLER SURGICAL ASSISTANT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:214-227-2457
Mailing Address - Street 1:1386 BROAD VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6502
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:972-463-7247
Practice Address - Street 1:1386 BROAD VALLEY CT
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6502
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:972-463-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00012364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-SurgicalGroup - Single Specialty