1841510021 NPI number — SURGICAL STAFFING, LLC

Table of content: CATHERINE GRACE COREY MD (NPI 1669054672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841510021 NPI number — SURGICAL STAFFING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL STAFFING, 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:
Provider Other Organization Name Type Code:
6
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:
1841510021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740383
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:
75374-0383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-954-7304
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7601 CHURCHILL WAY APT 621
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:
75251-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-954-7304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOOP
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-954-7304

Provider Taxonomy Codes

  • Taxonomy code: 163WR0006X , with the licence number:  653305 , 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)