1083788848 NPI number — PROASSIST SURGICAL ASSOCIATES, LLC

Table of content: (NPI 1083788848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083788848 NPI number — PROASSIST SURGICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROASSIST SURGICAL ASSOCIATES, LLC
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:
PROASSIST BILLING SOLUTIONS
Provider Other Organization Name Type Code:
5
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:
1083788848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2150 S CENTRAL EXPY
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-4070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-363-8200
Provider Business Mailing Address Fax Number:
972-363-8196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 S CENTRAL EXPY
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-4070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-363-8200
Provider Business Practice Location Address Fax Number:
972-363-8196
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FULLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
972-363-8200

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X , with the licence number:  CERT 82396 , 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: 412217629 . This is a "OLD TAX ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 613033500 . This is a "DOL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0062PC . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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