NPIMap

Organization Active NPI

Phenomsurgical Assisting

  • Surgical Assistant
  • Fresno, TX
National Provider Identifier
1376901843
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical AssistantTaxonomy code 246ZC0007X
License
SA00547 Issued in TX
Legal business name
PHENOMSURGICAL ASSISTING
Practice address
4026 E Teal Estates Cir
Fresno, TX 77545-8851
Phone
(510) 984-8610
NPI assigned
Jan 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gwendolyn Champion, LSANPI 1407241300
Title
Owner
Phone
(510) 984-8610

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 246ZC0007X SA00547 TX Primary

Addresses

Primary practice location

4026 E Teal Estates Cir
Fresno, TX 77545-8851

Mailing address

4026 E Teal Estates Cir
Fresno, TX 77545-8851
Phone (510) 984-8610

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1376901843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4026 E TEAL ESTATES CIR",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "775458851",
            "telephone_number": "510-984-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4026 E TEAL ESTATES CIR",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "775458851",
            "telephone_number": "510-984-8610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHENOMSURGICAL ASSISTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-29",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "CHAMPION",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-984-8610",
        "authorized_official_credential": "LSA"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "SA00547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.