Provider Demographics
NPI:1003894585
Name:ABRAHAM F SYRQUIN MD A PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ABRAHAM F SYRQUIN MD A PROFESSIONAL ASSOCIATION
Other - Org Name:NORTH CARRIER SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:FINKLEBERG
Authorized Official - Last Name:SYRQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-339-0990
Mailing Address - Street 1:8913 RACQUET CLUB DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-2839
Mailing Address - Country:US
Mailing Address - Phone:972-339-0990
Mailing Address - Fax:817-460-6183
Practice Address - Street 1:8913 RACQUET CLUB DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-2839
Practice Address - Country:US
Practice Address - Phone:972-339-0990
Practice Address - Fax:817-460-6183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10024805OtherAMERIGROUP
TX092971301Medicaid
TX451069Medicare PIN