1275574154 NPI number — DOCTORS SURGERY CENTER OF TEXARKANA

Table of content: (NPI 1275574154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275574154 NPI number — DOCTORS SURGERY CENTER OF TEXARKANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS SURGERY CENTER OF TEXARKANA
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:
DOCTOR'S SURGERY CENTER
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:
1275574154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3211 SUGAR HILL ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71854-9219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-772-4440
Provider Business Mailing Address Fax Number:
870-772-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3211 SUGAR HILL ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71854-9219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-772-4440
Provider Business Practice Location Address Fax Number:
870-772-7190
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEARSON
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER/M.D.
Authorized Official Telephone Number:
870-772-4440

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  AR3179 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 141621128 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145326801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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