Provider Demographics
NPI:1164478640
Name:SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-943-8605
Mailing Address - Street 1:221 W COLORADO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2363
Mailing Address - Country:US
Mailing Address - Phone:214-943-8605
Mailing Address - Fax:214-948-9846
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-943-8605
Practice Address - Fax:214-942-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7053208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097588001Medicaid
TX020027451OtherMARTIN KOONSMAN
TX118128101Medicaid
TX8U0030OtherDHIRESH ROHAN JEYARAJAH
TX126263603Medicaid
TXP00250455OtherDHIRESH ROHAN JEYARAJAH
TX020009489OtherRICHARD DICKERMAN
TX104687203Medicaid
TX144729404Medicaid
TXE10944Medicare UPIN
TXB22256Medicare UPIN
TX890586Medicare ID - Type UnspecifiedRICHARD DICKERMAN
TXG51602Medicare UPIN
TX8U0030OtherDHIRESH ROHAN JEYARAJAH
TX118128101Medicaid
TX8D8577Medicare ID - Type UnspecifiedDHIRESH ROHAN JEYARAJAH
TX097588001Medicaid
TX104687203Medicaid