Provider Demographics
NPI:1437935137
Name:NEUROSURGICAL AFFILIATES OF TEXAS, PA
Entity Type:Organization
Organization Name:NEUROSURGICAL AFFILIATES OF TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-441-0400
Mailing Address - Street 1:PO BOX 2700
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-2700
Mailing Address - Country:US
Mailing Address - Phone:916-441-0400
Mailing Address - Fax:916-441-0406
Practice Address - Street 1:613 ELIZABETH ST STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2221
Practice Address - Country:US
Practice Address - Phone:361-434-0966
Practice Address - Fax:361-356-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty