1376636167 NPI number — NORTH TEXAS NEUROSURGICAL ASSOCIATES

Table of content: (NPI 1376636167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376636167 NPI number — NORTH TEXAS NEUROSURGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS NEUROSURGICAL ASSOCIATES
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:
NEUROTREND
Provider Other Organization Name Type Code:
3
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:
1376636167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 835390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75083-5390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-239-1961
Provider Business Mailing Address Fax Number:
214-561-1641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1778 N PLANO RD
Provider Second Line Business Practice Location Address:
STE 112
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75081-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-239-1961
Provider Business Practice Location Address Fax Number:
214-561-1641
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
214-239-1961

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0071EE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H64080 . This is a "MEDICARE RAIL ROAD GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".