Healthcare Provider Details

I. General information

NPI: 1376707885
Provider Name (Legal Business Name): MOPREM SURGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 FOREST PARK RD SUITE 700
DALLAS TX
75235-6411
US

IV. Provider business mailing address

5920 FOREST PARK RD SUITE 700
DALLAS TX
75235-6411
US

V. Phone/Fax

Practice location:
  • Phone: 214-350-2400
  • Fax: 214-352-4862
Mailing address:
  • Phone: 214-350-2400
  • Fax: 214-352-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number008323
License Number StateTX

VIII. Authorized Official

Name: KIMBERLY BURTON
Title or Position: BUSINESS OFFICE SUPERVISOR
Credential:
Phone: 214-350-2400