=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255355715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGERY ASSOCIATES OF NORTH TEXAS P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 11/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3322 COLORADO BLVD SUITE 101
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-6864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-387-7588
-----------------------------------------------------
Fax | 940-566-0881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3322 COLORADO BLVD SUITE 101
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-6864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-387-7588
-----------------------------------------------------
Fax | 940-566-0881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING
-----------------------------------------------------
Name | DEBBY I SHYTLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 940-387-7588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------