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General NPI Number Information
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NPI Number | 1942717301
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Entity Type | Organization
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Legal Business Name | PREFERRED SURGICAL ASSOCIATES OF TEXAS
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 1208 PAINTBRUSH ST
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City | MESQUITE
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State | TX
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Zip | 75149-2634
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Provider Business Mailing Address
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Address Line | PO BOX 938
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City | ROWLETT
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State | TX
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Zip | 75030-0938
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOHNNY RAY STATON
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Credential | LSA
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Telephone | 214-980-9437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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