1164478640 NPI number — SURGICAL ASSOCIATES

Table of content: (NPI 1164478640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164478640 NPI number — SURGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL 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:
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:
1164478640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 W COLORADO BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75208-2363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-943-8605
Provider Business Mailing Address Fax Number:
214-948-9846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 W COLORADO BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75208-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-943-8605
Provider Business Practice Location Address Fax Number:
214-942-8463
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
214-943-8605

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  E7053 , 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: 097588001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020027451 . This is a "MARTIN KOONSMAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 118128101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8U0030 . This is a "DHIRESH ROHAN JEYARAJAH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126263603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00250455 . This is a "DHIRESH ROHAN JEYARAJAH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 020009489 . This is a "RICHARD DICKERMAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104687203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144729404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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