Henry Enrique Bolanos

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

SA00938 Issued in TX

Practice address

212 Staunton Dr
Leander, TX 78641-5469

Phone

(512) 644-1931

Fax

(214) 764-0880

NPI assigned

Feb 15, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 360 Surgical Assisting of Central Texas,LLC

  • Surgical Physician Assistant
  • Austin, TX
  • NPI 1790430072
  NPD
• River City Assisting, LLC

  • Surgical Assistant
  • Fredericksburg, TX
  • NPI 1891160032
  NPD

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

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695513600000",
    "number": "1548915820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 RILEY LN",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786243562",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 STAUNTON DR",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786415469",
            "telephone_number": "512-644-1931",
            "fax_number": "214-764-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "HENRY",
        "middle_name": "ENRIQUE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-15",
        "last_updated": "2023-09-24",
        "certification_date": "2023-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "196515",
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "SA00938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Water Homecare Inc. (Blue Water Senior Care LLC)
• Blue Water Hospice, LLC
• Bluebonnet Family Estates LLC
• Bluenile Medical Transport LLC
• Taylor Bohannan
• Kalen Bolton
• Tammy Lynn Bond
• Nayomie Bonilla-Guzman
• Brook Faye Bonnema, LPC
• Diane Patricia Bonsall, MSN, APRN, ACNS-BC

• Surgical Assistant in Leander, TX
• Providers in Leander, TX by specialty
• Surgical Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2023; 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.