Provider Demographics
NPI:1790957405
Name:SAN ANGELO NEUROSURGICAL ASSOCIATION
Entity Type:Organization
Organization Name:SAN ANGELO NEUROSURGICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-655-4164
Mailing Address - Street 1:211 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5902
Mailing Address - Country:US
Mailing Address - Phone:325-655-4164
Mailing Address - Fax:325-657-0875
Practice Address - Street 1:211 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5902
Practice Address - Country:US
Practice Address - Phone:325-655-4164
Practice Address - Fax:325-657-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7162207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010793001Medicaid
TX1227900001Medicare NSC