Provider Demographics
NPI:1235698911
Name:SOUTH TEXAS NEUROSURGERY ASSOCIATES
Entity type:Organization
Organization Name:SOUTH TEXAS NEUROSURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PISHARODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-541-6725
Mailing Address - Street 1:3475 W ALTON GLOOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-541-6725
Mailing Address - Fax:956-541-2070
Practice Address - Street 1:3475 W ALTON GLOOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-541-6725
Practice Address - Fax:956-541-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110116402Medicaid