1639236425 NPI number — SOUTHWEST VASCULAR AND SURGICAL GROUP

Table of content: (NPI 1639236425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639236425 NPI number — SOUTHWEST VASCULAR AND SURGICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST VASCULAR AND SURGICAL GROUP
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:
DALLAS SURGICAL GROUP
Provider Other Organization Name Type Code:
3
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:
1639236425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7777 FOREST LANE
Provider Second Line Business Mailing Address:
SUITE C-760
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75230-6801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-566-8039
Provider Business Mailing Address Fax Number:
972-566-2312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 FOREST LANE
Provider Second Line Business Practice Location Address:
SUITE C-760
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75230-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-566-8039
Provider Business Practice Location Address Fax Number:
972-566-2312
Provider Enumeration Date:
01/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
TANYA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
972-566-8039

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  E6012 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: J0020 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: J3706 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: K9914 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: L3839 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: H2239 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X , with the licence number: K7546 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X , with the licence number: E3311 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 083607401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".