Provider Demographics
NPI:1285978098
Name:NEUROSURGICAL PAS OF NORTH TEXAS, PA
Entity type:Organization
Organization Name:NEUROSURGICAL PAS OF NORTH TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-377-9200
Mailing Address - Street 1:4461 COIT RD.
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-377-9200
Mailing Address - Fax:972-377-9300
Practice Address - Street 1:4461 COIT RD.
Practice Address - Street 2:SUITE 405
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-377-9200
Practice Address - Fax:972-377-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07007363AS0400X
TXPA07772363AS0400X
TXPA06349363AS0400X
TXPA05731363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty