Provider Demographics
NPI:1225222482
Name:VISTA SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:VISTA SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-522-4940
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:505-522-4940
Mailing Address - Fax:505-522-4932
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:505-522-4940
Practice Address - Fax:505-522-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2007-0561208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty