Provider Demographics
NPI:1538590468
Name:SPACE CENTER SA SERVICES, INC
Entity type:Organization
Organization Name:SPACE CENTER SA SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-804-8704
Mailing Address - Street 1:7324 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 1550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2012
Mailing Address - Country:US
Mailing Address - Phone:713-988-8400
Mailing Address - Fax:
Practice Address - Street 1:7324 SOUTHWEST FWY
Practice Address - Street 2:SUITE 1550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2012
Practice Address - Country:US
Practice Address - Phone:713-988-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SURGICAL HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty