Provider Demographics
NPI:1598099319
Name:LU LIU FIRST ASSIST PLLC
Entity Type:Organization
Organization Name:LU LIU FIRST ASSIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL PA-C
Authorized Official - Prefix:
Authorized Official - First Name:LU
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:972-264-8575
Mailing Address - Street 1:615 TERESA LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2816
Mailing Address - Country:US
Mailing Address - Phone:972-264-8575
Mailing Address - Fax:972-264-8575
Practice Address - Street 1:615 TERESA LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2816
Practice Address - Country:US
Practice Address - Phone:972-264-8575
Practice Address - Fax:972-264-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02204363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187944701OtherINDIVIDUAL MEDICAID NUMBER
TX82N820OtherINDIVIDUAL MEDICARE PIN NUMBER
TXS60053OtherINDIVIDUAL MEDICARE UPIN NUMBER
1093776635OtherINDIVIDUAL NPI NUMBER