1750595054 NPI number — TRI-COUNTY SURGICAL ASSOCIATES, P.A.

Table of content: (NPI 1750595054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750595054 NPI number — TRI-COUNTY SURGICAL ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-COUNTY SURGICAL ASSOCIATES, 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:
1750595054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2569
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77497-2569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-664-1330
Provider Business Mailing Address Fax Number:
713-664-3355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 BLUEBONNET DR
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77477-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-664-1330
Provider Business Practice Location Address Fax Number:
713-664-3355
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALAT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE DIRECTOR
Authorized Official Telephone Number:
713-664-1330

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com