Provider Demographics
NPI:1780961045
Name:TEXAS NEUROSURGICAL INSTITUTE PA
Entity type:Organization
Organization Name:TEXAS NEUROSURGICAL INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, FNP-C, RNFA
Authorized Official - Phone:972-529-0480
Mailing Address - Street 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:SUITE 830 PAVILION I
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5340
Mailing Address - Country:US
Mailing Address - Phone:972-529-0480
Mailing Address - Fax:
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:SUITE 830 PAVILION I
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5340
Practice Address - Country:US
Practice Address - Phone:972-529-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633384363LF0000X
TXN8183207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty