1184784951 NPI number — NEUROSURGICAL ASSOCIATES OF TEXARKANA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184784951 NPI number — NEUROSURGICAL ASSOCIATES OF TEXARKANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGICAL ASSOCIATES OF TEXARKANA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184784951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9600
Provider Second Line Business Mailing Address:
DEPT 09-019
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75505-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-794-4196
Provider Business Mailing Address Fax Number:
903-792-7408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 TEXAS BLVD
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75501-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-794-4196
Provider Business Practice Location Address Fax Number:
903-792-7408
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
BILL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
903-794-4196

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  K1252 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00DG35 . This is a "INDIGENT HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91421 . This is a "FIRST PYRAMID LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91421 . This is a "BLUE CROSS OF ARKANSAS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 094806902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100752110A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179117500 . This is a "US DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00DG35 . This is a "TEXAS BLUE CROSS GP NO#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 113562002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53713 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91421 . This is a "COLLUM & CARNEY CLINC" identifier . This identifiers is of the category "OTHER".
  • Identifier: CP4245 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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