Basic Information
| Provider Information | |||||||||
| NPI: | 1477892750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED PA SURGICAL SERVICES OF NORTH TEXAS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 CARIBOU DR | ||||||||
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| City: | PROSPER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750787066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652840493 | ||||||||
| FaxNumber: | 7652842434 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 N HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750927354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038704611 | ||||||||
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| ProviderEnumerationDate: | 02/06/2013 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | SHORE | ||||||||
| AuthorizedOfficialFirstName: | SHAUN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4693636333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.