Provider Demographics
NPI:1508055658
Name:TOMASZEK NEUROSURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:TOMASZEK NEUROSURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TOMASZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-321-1130
Mailing Address - Street 1:26710 I-45 NORTH
Mailing Address - Street 2:SUITE B9
Mailing Address - City:OAK RIDGE NORTH
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1015
Mailing Address - Country:US
Mailing Address - Phone:936-321-1130
Mailing Address - Fax:936-321-1230
Practice Address - Street 1:26710 I-45 NORTH
Practice Address - Street 2:SUITE B9
Practice Address - City:OAK RIDGE NORTH
Practice Address - State:TX
Practice Address - Zip Code:77386-1015
Practice Address - Country:US
Practice Address - Phone:936-321-1130
Practice Address - Fax:936-321-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC86795207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170784601Medicaid
TX00219VMedicare PIN