Healthcare Provider Details

I. General information

NPI: 1477892750
Provider Name (Legal Business Name): UNITED PA SURGICAL SERVICES OF NORTH TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIGHLAND AVE
SHERMAN TX
75092-7354
US

IV. Provider business mailing address

960 CARIBOU DR
PROSPER TX
75078-7066
US

V. Phone/Fax

Practice location:
  • Phone: 903-870-4611
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax: 765-284-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SHAUN SHORE
Title or Position: OWNER
Credential:
Phone: 469-363-6333