Fall Creek Surgical Assistants

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

SA00132 Issued in TX

Legal business name

FALL CREEK SURGICAL ASSISTANTS

Practice address

1504 Kelsey Dr
Keller, TX 76248-6878

Phone

(817) 605-0991

Fax

(817) 605-0993

NPI assigned

Oct 15, 2007

Organization subpart

No

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

Authorized official

Name

Gregory B McCleery, LSA

Title

President

Phone

(817) 605-0991

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1952590077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820428",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761820428",
            "telephone_number": "817-605-0991",
            "fax_number": "817-605-0993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 KELSEY DR",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762486878",
            "telephone_number": "817-605-0991",
            "fax_number": "817-605-0993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALL CREEK SURGICAL ASSISTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "MCCLEERY",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-605-0991",
        "authorized_official_credential": "LSA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "SA00132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Extended Grace Home Healthcare, LLC
• Lori Ann Neill Faglie, FNP-C
• Victoria Faglie
• Jaclyn Louise Fahey
• Nicole Marie Fakoory, MA CCC-SLP
• Ronald Faries, DC
• Leslie Marie Faris, PH.D.
• Mary Sue Farrier, OTR
• Sabrina Farthing
• Taylor Fater

• Surgical Physician Assistant in Keller, TX
• Providers in Keller, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; 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.