1942974597 NPI number — SURGICAL SERVICES OF TEXAS PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942974597 NPI number — SURGICAL SERVICES OF TEXAS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SERVICES OF TEXAS PLLC
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:
1942974597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLETT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75030-2550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-227-2457
Provider Business Mailing Address Fax Number:
214-764-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11936 RAVENVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75253-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-227-2457
Provider Business Practice Location Address Fax Number:
214-764-0880
Provider Enumeration Date:
08/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
COLON
Authorized Official First Name:
CALEB
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-227-2457

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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