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Organization

ATHENS SURGICAL ASSOC., P A

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. DONNA M PUGH (ADMINISTRATOR)
(903) 675-5781
Entity
Organization

Contact information

Practice address
115 MEDICAL CIR, SUITE 107, ATHENS, TX 75751-9003
(903) 675-5781
(903) 677-1008
Mailing address
PO BOX C, ATHENS, TX 75751-1078
(903) 675-5781
(903) 677-1008

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00N482
BCBS
TX
05
084202301
TX
Enumeration date
03/13/2007
Last updated
08/31/2012
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