Provider Demographics
NPI:1295926467
Name:LAS COLINAS SURGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:LAS COLINAS SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-558-9439
Mailing Address - Street 1:PO BOX 630372
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0372
Mailing Address - Country:US
Mailing Address - Phone:214-558-9439
Mailing Address - Fax:214-206-1489
Practice Address - Street 1:1 MEDICAL PKWY
Practice Address - Street 2:STE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7841
Practice Address - Country:US
Practice Address - Phone:214-558-9439
Practice Address - Fax:214-206-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1383208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00084TOtherMEDICARE GROUP ID NUMBER
TX00084TOtherMEDICARE GROUP ID NUMBER