Provider Demographics
NPI:1194086710
Name:PROFESSIONAL ASSISTANT SERVICES PA
Entity type:Organization
Organization Name:PROFESSIONAL ASSISTANT SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-306-8065
Mailing Address - Street 1:400 W LBJ FWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3718
Mailing Address - Country:US
Mailing Address - Phone:214-306-8065
Mailing Address - Fax:972-506-8733
Practice Address - Street 1:400 W LBJ FWY
Practice Address - Street 2:SUITE 330
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3718
Practice Address - Country:US
Practice Address - Phone:214-306-8065
Practice Address - Fax:972-506-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty