1346298486 NPI number — SURGERY ASSOCIATES OF TEXARKANA, P.A.

Table of content: (NPI 1346298486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346298486 NPI number — SURGERY ASSOCIATES OF TEXARKANA, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY ASSOCIATES OF TEXARKANA, P.A.
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:
1346298486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 GALLERIA OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-4619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-792-6114
Provider Business Mailing Address Fax Number:
903-792-7876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 GALLERIA OAKS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-792-6114
Provider Business Practice Location Address Fax Number:
903-792-7876
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
903-792-6114

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 77868 . This is a "LOUISIANA BLUE CROSS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A60J . This is a "TEXAS BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 81394 . This is a "ARK BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: CS3854 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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