Provider Demographics
NPI:1265770036
Name:NORTH TEXAS SURGICAL ASSISTANT
Entity type:Organization
Organization Name:NORTH TEXAS SURGICAL ASSISTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-344-6916
Mailing Address - Street 1:1194 OVERLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-0000
Mailing Address - Country:US
Mailing Address - Phone:682-583-1469
Mailing Address - Fax:
Practice Address - Street 1:1194 OVERLAND DRIVE
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-9999
Practice Address - Country:US
Practice Address - Phone:682-583-1469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty