Provider Demographics
NPI:1346298486
Name:SURGERY ASSOCIATES OF TEXARKANA, P.A.
Entity Type:Organization
Organization Name:SURGERY ASSOCIATES OF TEXARKANA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-792-6114
Mailing Address - Street 1:1920 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4619
Mailing Address - Country:US
Mailing Address - Phone:903-792-6114
Mailing Address - Fax:903-792-7876
Practice Address - Street 1:1920 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4619
Practice Address - Country:US
Practice Address - Phone:903-792-6114
Practice Address - Fax:903-792-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA77868OtherLOUISIANA BLUE CROSS
TX00A60JOtherTEXAS BLUE CROSS
AR81394OtherARK BLUE CROSS
TXCS3854OtherTRAVELERS MEDICARE
TXA-60JMedicare ID - Type Unspecified