Provider Demographics
NPI:1427626696
Name:RADIANT SURGICAL SPECIALISTS OF NORTH TEXAS PLLC
Entity type:Organization
Organization Name:RADIANT SURGICAL SPECIALISTS OF NORTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-273-6113
Mailing Address - Street 1:PO BOX 2017
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0034
Mailing Address - Country:US
Mailing Address - Phone:828-273-6113
Mailing Address - Fax:
Practice Address - Street 1:1105 CENTRAL EXPY N STE 2350
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6116
Practice Address - Country:US
Practice Address - Phone:972-767-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty