Provider Demographics
NPI:1275578338
Name:NORTH TEXAS COLON & RECTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:NORTH TEXAS COLON & RECTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-824-1730
Mailing Address - Street 1:3701 JUNIUS ST # H015
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2026
Mailing Address - Country:US
Mailing Address - Phone:214-824-1730
Mailing Address - Fax:214-821-7756
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-824-1730
Practice Address - Fax:214-821-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3321208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081510201Medicaid
TXCS9237OtherRAILROAD MEDICARE
TX081510201Medicaid