Basic Information
| Provider Information | |||||||||
| NPI: | 1760826713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROASSIT | ||||||||
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| OtherOrganizationName: | BAYLOR MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 S CENTRAL EXPY # 75070 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750704070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723638200 | ||||||||
| FaxNumber: | 9723638196 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 S CENTRAL EXPY # 75070 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750704070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723638200 | ||||||||
| FaxNumber: | 9723638196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2013 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | SHRESTHA | ||||||||
| AuthorizedOfficialFirstName: | MAUSAMI | ||||||||
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| AuthorizedOfficialTitleorPosition: | SURGICAL ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2142269168 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 281P00000X | N | Hospitals | Chronic Disease Hospital | 261QS0112X | N | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.