Provider Demographics
NPI:1306898572
Name:SOMERSET SURGICAL ASSOCIATES,PA
Entity type:Organization
Organization Name:SOMERSET SURGICAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VITTIMBERGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:972-298-2875
Mailing Address - Street 1:3450 W WHEATLAND RD
Mailing Address - Street 2:POB II, SUITE 330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3470
Mailing Address - Country:US
Mailing Address - Phone:972-298-2875
Mailing Address - Fax:214-239-4964
Practice Address - Street 1:3450 W WHEATLAND RD
Practice Address - Street 2:POB II, SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3470
Practice Address - Country:US
Practice Address - Phone:972-298-2875
Practice Address - Fax:214-239-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178672501Medicaid
TX178672501Medicaid