1467491837 NPI number — NEUROSURGICAL ASSOCIATES , LLP

Table of content: (NPI 1467491837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467491837 NPI number — NEUROSURGICAL ASSOCIATES , LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGICAL 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:
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:
1467491837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3419 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79410-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-796-3000
Provider Business Mailing Address Fax Number:
806-796-3006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3419 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-796-3000
Provider Business Practice Location Address Fax Number:
806-796-3006
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
MINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
806-776-1614

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , 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)

  • Identifier: Q5076 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080262101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0026BM . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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