MEDICARE: SURGICAL SPECIALISTS OF PLANO PA

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

General Provider Information

NPI Number	:	1528127313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALISTS OF PLANO PA

Provider Business Mailing Address
First Line	:	4001 W 15TH ST STE 180
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5836
Country	:	US
Telephone Number	:	972-596-5225
Fax Number	:	972-985-9782

Provider Business Practice Location Address
First Line	:	4001 W 15TH ST STE 180
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5836
Country	:	US
Telephone Number	:	972-596-5225
Fax Number	:	972-985-9782

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD F ELLER
Credential	:	MD
Telephone Number	:	972-596-5225

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	08/22/2020

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