Provider Demographics
NPI:1083788848
Name:PROASSIST SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PROASSIST SURGICAL ASSOCIATES, LLC
Other - Org Name:PROASSIST BILLING SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:972-363-8200
Mailing Address - Street 1:2150 S CENTRAL EXPY
Mailing Address - Street 2:STE 130
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4070
Mailing Address - Country:US
Mailing Address - Phone:972-363-8200
Mailing Address - Fax:972-363-8196
Practice Address - Street 1:2150 S CENTRAL EXPY
Practice Address - Street 2:STE 130
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4070
Practice Address - Country:US
Practice Address - Phone:972-363-8200
Practice Address - Fax:972-363-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCERT 82396246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX412217629OtherOLD TAX ID
TX613033500OtherDOL
TX0062PCOtherBCBS
TX412217629OtherOLD TAX ID
TX0A51222Medicare PIN
TX0A5199Medicare PIN