1467621011 NPI number — METROPLEX SURGICAL ARTS, P.A.

Table of content: (NPI 1467621011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467621011 NPI number — METROPLEX SURGICAL ARTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPLEX SURGICAL ARTS, P.A.
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:
1467621011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7988 W VIRGINIA DR SUITE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-296-1992
Provider Business Mailing Address Fax Number:
972-296-8983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7988 W VIRGINIA DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-296-1992
Provider Business Practice Location Address Fax Number:
972-296-8983
Provider Enumeration Date:
02/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOKE
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER/SURGEON
Authorized Official Telephone Number:
972-296-1992

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  18861 , 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)