MEDICARE: SURGERY ASSOCIATES OF NORTH TEXAS P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician
2	2086S0129X	Vascular Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00MT04	OTHER	TX	BLUE CROSS OF TEXAS

General Provider Information

NPI Number	:	1255355715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY ASSOCIATES OF NORTH TEXAS P A

Provider Business Mailing Address
First Line	:	3322 COLORADO BLVD
Second Line	:	SUITE 101
City	:	DENTON
State	:	TX
Zip	:	76210-6864
Country	:	US
Telephone Number	:	940-387-7588
Fax Number	:	940-566-0881

Provider Business Practice Location Address
First Line	:	3322 COLORADO BLVD
Second Line	:	SUITE 101
City	:	DENTON
State	:	TX
Zip	:	76210-6864
Country	:	US
Telephone Number	:	940-387-7588
Fax Number	:	940-566-0881

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	DEBBY I SHYTLES
Credential	:
Telephone Number	:	940-387-7588

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	11/05/2009

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Directions to “SURGERY ASSOCIATES OF NORTH TEXAS P A ” Practice Location

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