Provider Demographics
NPI:1326292194
Name:MEDICAL AND SURGICAL ASSOCIATES OF CORSICANA
Entity Type:Organization
Organization Name:MEDICAL AND SURGICAL ASSOCIATES OF CORSICANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-872-3005
Mailing Address - Street 1:401 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2415
Mailing Address - Country:US
Mailing Address - Phone:903-872-3005
Mailing Address - Fax:903-872-3050
Practice Address - Street 1:219 WEST 6TH AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4895
Practice Address - Country:US
Practice Address - Phone:903-874-5866
Practice Address - Fax:903-874-5083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL AND SURGICAL ASSOCIATES OF CORSICANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-06
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1922298199OtherNPI
TX00Y226OtherMEDICARE GROUP PTAN
TX189750601Medicaid