Provider Demographics
NPI:1487787198
Name:ATHENS SURGICAL ASSOC., P A
Entity type:Organization
Organization Name:ATHENS SURGICAL ASSOC., P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-675-5781
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-1078
Mailing Address - Country:US
Mailing Address - Phone:903-675-5781
Mailing Address - Fax:903-677-1008
Practice Address - Street 1:115 MEDICAL CIR
Practice Address - Street 2:SUITE 107
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9003
Practice Address - Country:US
Practice Address - Phone:903-675-5781
Practice Address - Fax:903-677-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N482OtherBCBS
TX084202301Medicaid
TX084202301Medicaid