Organization
PROVECTUS MEDICORUM SURGICAL ASSIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY SWEET (BILLING MANAGER)
(281) 730-1216
Entity
Organization
Contact information
Practice address
118 VINTAGE PARK BLVD STE W, HOUSTON, TX 77070-4096
(281) 730-1216
(281) 668-6374
Mailing address
PO BOX 11561, HOUSTON, TX 77293-1561
(281) 730-1216
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00318
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA00318
STATE LICENSE
TX
Enumeration date
06/15/2017
Last updated
07/21/2022
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