Provider Demographics
NPI:1124362504
Name:NORTH TEXAS SURGICAL ONCOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NORTH TEXAS SURGICAL ONCOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-578-8877
Mailing Address - Street 1:4001 W 15TH ST STE 425
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5848
Mailing Address - Country:US
Mailing Address - Phone:972-696-0030
Mailing Address - Fax:972-612-6800
Practice Address - Street 1:4001 W 15TH ST STE 425
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5848
Practice Address - Country:US
Practice Address - Phone:972-696-0030
Practice Address - Fax:972-696-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-25
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330934601Medicaid
TX0015YGOtherBCBS