1558413427 NPI number — NEUROSURGICAL ASSOCIATES OF TEXARKANA, INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558413427 NPI number — NEUROSURGICAL ASSOCIATES OF TEXARKANA, INC.

Employer Identification Number (EIN):

Provider Organization Name:

NEUROSURGICAL ASSOCIATES OF TEXARKANA, INC.

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1558413427

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/04/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 9600

Provider Second Line Business Mailing Address:

DEPT 09-019

Provider Business Mailing Address City Name:

TEXARKANA

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75505-9600

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

903-794-4196

Provider Business Mailing Address Fax Number:

903-792-7408

Provider First Line Business Practice Location Address:

1002 TEXAS BLVD STE 406

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:

75501-5113

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

903-794-4196

Provider Business Practice Location Address Fax Number:

903-792-7408

Provider Enumeration Date:

01/18/2007

Authorized Official Last Name:

CURTIS

Authorized Official First Name:

BILL

Authorized Official Middle Name:

Authorized Official Title or Position:

OFFICE ADMINISTRATOR

Authorized Official Telephone Number:

903-794-4196

• Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 91421 . This is a "FIRST PYRAMID LIFE" identifier . This identifiers is of the category "OTHER".
• Identifier: CP4245 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: MDK0047 . This is a "REHAB" identifier . This identifiers is of the category "OTHER".
• Identifier: 113562002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 00DG35 . This is a "INDIGENT HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 53713 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 179117500 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 91421 . This is a "BLUE CROSS ARK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 00DG45 . This is a "BLUE CROSS TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 094806902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 100752110A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: 91421 . This is a "COLLUM & CARNEY CLINIC" identifier . This identifiers is of the category "OTHER".