Basic Information
| Provider Information | |||||||||
| NPI: | 1346298486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGERY ASSOCIATES OF TEXARKANA, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 GALLERIA OAKS DR | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755034619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037926114 | ||||||||
| FaxNumber: | 9037927876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1920 GALLERIA OAKS DR | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755034619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037926114 | ||||||||
| FaxNumber: | 9037927876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9037926114 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 77868 | 01 | LA | LOUISIANA BLUE CROSS | OTHER | 00A60J | 01 | TX | TEXAS BLUE CROSS | OTHER | 81394 | 01 | AR | ARK BLUE CROSS | OTHER | CS3854 | 01 | TX | TRAVELERS MEDICARE | OTHER |