Provider Demographics
NPI:1033259684
Name:MEISELBACH, STEVEN WAYNE (LSA, CSA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:MEISELBACH
Suffix:
Gender:M
Credentials:LSA, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-0901
Mailing Address - Country:US
Mailing Address - Phone:281-412-7798
Mailing Address - Fax:281-412-7798
Practice Address - Street 1:3406 HICKORY CREEK DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-2453
Practice Address - Country:US
Practice Address - Phone:281-412-7798
Practice Address - Fax:281-412-7798
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00218246ZS0410X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8N4574OtherBCBS PROVIDER