Provider Demographics
NPI:1528127313
Name:SURGICAL SPECIALISTS OF PLANO PA
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF PLANO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-596-5225
Mailing Address - Street 1:4001 W 15TH ST STE 180
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5836
Mailing Address - Country:US
Mailing Address - Phone:972-596-5225
Mailing Address - Fax:972-985-9782
Practice Address - Street 1:4001 W 15TH ST STE 180
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5836
Practice Address - Country:US
Practice Address - Phone:972-596-5225
Practice Address - Fax:972-985-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00136TMedicare ID - Type Unspecified