Provider Demographics
NPI:1497062434
Name:NEIL H. SARETSKY, M.D., P.A.
Entity Type:Organization
Organization Name:NEIL H. SARETSKY, M.D., P.A.
Other - Org Name:SIERRA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SARETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-368-4970
Mailing Address - Street 1:5468 LA SIERRA DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-368-4970
Mailing Address - Fax:214-368-0177
Practice Address - Street 1:5468 LA SIERRA DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-368-4970
Practice Address - Fax:214-368-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6909174400000X, 208200000X
TXF1097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB111651Medicare PIN
TX00SE12Medicare PIN