Provider Demographics
NPI:1467491837
Name:NEUROSURGICAL ASSOCIATES , LLP
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES , LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-776-1614
Mailing Address - Street 1:3419 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1334
Mailing Address - Country:US
Mailing Address - Phone:806-796-3000
Mailing Address - Fax:806-796-3006
Practice Address - Street 1:3419 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1334
Practice Address - Country:US
Practice Address - Phone:806-796-3000
Practice Address - Fax:806-796-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ5076Medicaid
TX080262101Medicaid
TX0026BMOtherBCBS
NMQ5076Medicaid
TXCD3080Medicare PIN