Organization
ULTIMATE SURGICAL ASSISTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA DIANE LACKEY (OFFICE MANAGER)
(972) 270-4800
Entity
Organization
Contact information
Practice address
1151 N BUCKNER BLVD, SUITE 308, DALLAS, TX 75218-3426
(972) 270-4800
(214) 367-1153
Mailing address
1151 N BUCKNER BLVD, SUITE 308, DALLAS, TX 75218-3426
(972) 270-4800
(214) 367-1153
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
667351
TX
Other
Enumeration date
11/10/2008
Last updated
11/10/2008
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