1285910885 NPI number — DALLAS SURGICAL ASSISTANCE

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 1285910885 NPI number — DALLAS SURGICAL ASSISTANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS SURGICAL ASSISTANCE
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:
1285910885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 670531
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:
75367-0531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-618-5600
Provider Business Mailing Address Fax Number:
214-618-7733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5666 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-618-5600
Provider Business Practice Location Address Fax Number:
214-618-7733
Provider Enumeration Date:
10/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SIVARAMAN
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
214-618-5600

Provider Taxonomy Codes

  • Taxonomy code: 163WR0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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