Provider Demographics
NPI:1639520653
Name:TEXAS SURGICAL ARTS
Entity Type:Organization
Organization Name:TEXAS SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-579-5638
Mailing Address - Street 1:21720 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 303A
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2550
Mailing Address - Country:US
Mailing Address - Phone:281-579-5638
Mailing Address - Fax:
Practice Address - Street 1:21720 KINGSLAND BLVD
Practice Address - Street 2:SUITE 303A
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2550
Practice Address - Country:US
Practice Address - Phone:281-579-5638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5679302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL5679OtherSTATE LICENSE