Basic Information
| Provider Information | |||||||||
| NPI: | 1558413427 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEUROSURGICAL ASSOCIATES OF TEXARKANA, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 9600 | ||||||||
| Address2: | DEPT 09-019 | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755059600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037944196 | ||||||||
| FaxNumber: | 9037927408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 TEXAS BLVD STE 406 | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037944196 | ||||||||
| FaxNumber: | 9037927408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CURTIS | ||||||||
| AuthorizedOfficialFirstName: | BILL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9037944196 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 91421 | 01 | FIRST PYRAMID LIFE | OTHER | CP4245 | 01 | TX | RAILROAD MEDICARE | OTHER | MDK0047 | 01 | REHAB | OTHER | 113562002 | 05 | AR | MEDICAID | 00DG35 | 01 | INDIGENT HEALTH CARE | OTHER | 53713 | 01 | CHAMPUS | OTHER | 179117500 | 01 | US DEPT OF LABOR | OTHER | 91421 | 01 | AR | BLUE CROSS ARK | OTHER | 00DG45 | 01 | TX | BLUE CROSS TEXAS | OTHER | 094806902 | 05 | TX | MEDICAID | 100752110A | 05 | OK | MEDICAID | 91421 | 01 | COLLUM & CARNEY CLINIC | OTHER |