1306846464 NPI number — TSA-TEXAS SURGICAL ASSOCIATES LLP

Table of content: (NPI 1306846464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306846464 NPI number — TSA-TEXAS SURGICAL ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TSA-TEXAS SURGICAL ASSOCIATES LLP
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:
TEXAS SURGICAL ASSOCIATES, PA
Provider Other Organization Name Type Code:
4
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:
1306846464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77253-3567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-776-0655
Provider Business Mailing Address Fax Number:
713-776-1069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7737 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-776-0655
Provider Business Practice Location Address Fax Number:
713-776-1069
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRACTICE ADMIN MANAGER
Authorized Official Telephone Number:
832-709-1418

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0003BD . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 095036202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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