Provider Demographics
NPI:1972033405
Name:PRIME NEUROSURGEON PLLC
Entity Type:Organization
Organization Name:PRIME NEUROSURGEON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRC
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-378-4656
Mailing Address - Street 1:PO BOX 674074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8080 PARK LN STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5926
Practice Address - Country:US
Practice Address - Phone:214-378-4656
Practice Address - Fax:866-375-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty