BLUEJACK SURGICAL AFFILIATES NPI 1043869100

NPI Information

NPI: 1043869100
Provider Name: BLUEJACK SURGICAL AFFILIATES
Classification: Physician Assistant - 363AS0400X
Entity Type: Organization

Specialization: Surgical

Address:
1202 E ARAPAHO RD STE 122
RICHARDSON, TX
ZIP 75081
Phone: (469) 250-4422
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BLUEJACK SURGICAL AFFILIATES is a surgical physician assistant in Richardson, TX. BLUEJACK SURGICAL AFFILIATES NPI is 1043869100. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1202 E ARAPAHO RD STE 122
RICHARDSON, TX
ZIP 75081-400
Phone: (469) 250-4422
Fax: (469) 250-7068

The provider's authorized official is Christopher John Brock .
The authorized official title is Managing Partner and has the following contact phone number (972) 979-6222.

The enumeration date for this NPI number is 9/10/2019 and was last updated on 9/10/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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