Organization
TEXARKANA SURGICAL FIRST ASSISTANT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WENDY GORDON LSA (LSA)
(817) 294-7444
Entity
Organization
Contact information
Practice address
2600 SAINT MICHAEL DR, TEXARKANA, TX 75503-2372
(903) 614-1000
Mailing address
PO BOX 11219, FORT WORTH, TX 76110-0219
(817) 294-7444
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA00281
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0055FL
BCBSTX
TX
01
—
SA00281
LICENSE NUMBER
TX
Enumeration date
04/04/2007
Last updated
02/04/2010
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