Provider Demographics
NPI:1366630170
Name:HALSTED SURGICAL ASSOCIATION
Entity Type:Organization
Organization Name:HALSTED SURGICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANGELINA
Authorized Official - Last Name:HALSTED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-593-9800
Mailing Address - Street 1:7408 UMBRIA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3505
Mailing Address - Country:US
Mailing Address - Phone:915-593-9800
Mailing Address - Fax:915-593-9805
Practice Address - Street 1:10201 GATEWAY BLVD W STE 420
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7647
Practice Address - Country:US
Practice Address - Phone:915-593-9800
Practice Address - Fax:915-593-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2048208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036DUOtherBCBS