Provider Demographics
NPI:1114019783
Name:NORTH TEXAS MEDICAL SURGICAL CLINIC PA
Entity Type:Organization
Organization Name:NORTH TEXAS MEDICAL SURGICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:BLUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-898-7400
Mailing Address - Street 1:2509 SCRIPTURE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2337
Mailing Address - Country:US
Mailing Address - Phone:940-898-7400
Mailing Address - Fax:940-387-7327
Practice Address - Street 1:2509 SCRIPTURE ST
Practice Address - Street 2:STE 200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2337
Practice Address - Country:US
Practice Address - Phone:940-898-7400
Practice Address - Fax:940-387-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0819997 01Medicaid
TX00D15NMedicare PIN