Provider Demographics
NPI:1528377678
Name:NORTH TEXAS TEAM CARE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTH TEXAS TEAM CARE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KIKKERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-681-7246
Mailing Address - Street 1:PO BOX 870638
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75187-0638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3865 CHILDRESS AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-681-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical