Provider Demographics
NPI:1255355715
Name:SURGERY ASSOCIATES OF NORTH TEXAS P A
Entity type:Organization
Organization Name:SURGERY ASSOCIATES OF NORTH TEXAS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEBBY
Authorized Official - Middle Name:I
Authorized Official - Last Name:SHYTLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-387-7588
Mailing Address - Street 1:3322 COLORADO BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6864
Mailing Address - Country:US
Mailing Address - Phone:940-387-7588
Mailing Address - Fax:940-566-0881
Practice Address - Street 1:3322 COLORADO BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6864
Practice Address - Country:US
Practice Address - Phone:940-387-7588
Practice Address - Fax:940-566-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083992001Medicaid
TX00MT04OtherBLUE CROSS OF TEXAS
00MT04Medicare ID - Type Unspecified