1376729277 NPI number — BORGER SURGICAL ASSOC

Table of content: (NPI 1376729277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376729277 NPI number — BORGER SURGICAL ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BORGER SURGICAL ASSOC
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:
1376729277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13410 PRESTON RD
Provider Second Line Business Mailing Address:
#C-425
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-5299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-295-5050
Provider Business Mailing Address Fax Number:
214-295-5030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234-7858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-295-5050
Provider Business Practice Location Address Fax Number:
214-295-5030
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
SALOMON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-295-5050

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  L5204 , 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)





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