BLUEJACK SURGICAL AFFILIATES (NPI# 1043869100) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043869100 |
| Entity Type | Organization |
| Organization Name | BLUEJACK SURGICAL AFFILIATES |
| Practice Address |
1202 E Arapaho Rd Ste 122 Richardson TX 75081-2400 |
| Practice Telephone | 4692504422 |
| Practice Fax Number | 4692507068 |
| Mailing Telephone | 4692504422 |
| Mailing Fax Number | 4692507068 |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2019-09-10 |
| Authorized Official Name | CHRISTOPHER JOHN BROCK (MANAGING PARTNER) |
| Authorized Official Telephone | 9729796222 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1202 E ARAPAHO RD STE 122 |
| City | RICHARDSON |
| State | TX |
| Zip Code | 75081-2400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174879159 | Breck James Wheelock | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2012-07-27 |
| 1699376459 | Oakmont Surgical Affiliates | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2020-11-06 |
| 1073114443 | Texassist Surgical Assist Staffing | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2020-11-03 |
| 1053927111 | Patient Plus | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2020-09-23 |
| 1528542008 | Surgical Assist Solutions | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2018-09-20 |
| 1801398730 | Centralassist | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2477 | 2018-03-07 |
| 1760982060 | Assistant Specialists | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2477 | 2018-02-14 |
| 1093243115 | Ashley M Kalvaitis | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2017-06-02 |
| 1326498098 | Southassist, LLC | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2477 | 2016-06-14 |
| 1750773131 | Kristopher Holmes | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2015-02-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992305619 | Kasaundra Deleon | Pharmacy | 802 E Us Hwy, Richardson, TX 75081 | 2020-10-30 |
| 1265076806 | Stateserv Medical of Texas | Durable Medical Equipment & Medical Supplies | 1207 N. Glenview Drive, Richardson, TX 75081 | 2019-11-06 |
| 1831732890 | Cielo Camille Lopez | Registered Nurse | 908 Audelia Rd St. 200-pmb 170, Richardon, TX 75081 | 2019-10-23 |
| 1154963007 | Alex Robert Langford | Technician, Other | 1901 N. Glenville Dr., Suite 501, Richardson, TX 75081 | 2019-10-11 |
| 1427530849 | Ladasha Danelle Gregory | Occupational Therapy Assistant | 744 Brick Row Dr Apt 2226, Richardson, TX 75081 | 2018-09-01 |
| 1013403427 | Camp Medical Management, LLC | Social Worker | 208 W. Spring Valley Rd, Richardson, TX 75081 | 2018-07-09 |
| 1710486238 | Sara Nourani-dargiri | Optometrist | 1332 S. Plano Rd Ste 112, Richardson, TX 75081 | 2018-02-10 |
| 1174044895 | Rebecka Kay Haats | Dentist | 644 Brick Row Dr. Apt 3211, Richardson, TX 75081 | 2017-07-03 |
| 1225418635 | Elizabeth Bands | Pharmacist | 930 East Campbell, Suite 200, Richardson, TX 75081 | 2015-06-02 |
| 1518344597 | Relationship Resolve | Public Health or Welfare | 800 Security Row, Suite 2, Richardson, TX 75081 | 2015-04-29 |
| Find all providers in zip 75081 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700250859 | Spine Surgical Services, Pllc | Physician Assistant | 908 Audelia Rd Ste 200-308, Richardson, TX 75081-5166 | 2015-11-30 |
| 1285018929 | Bk Assist, Pllc | Physician Assistant | 101 S Coit Rd Ste 36-267, Richardson, TX 75080-5743 | 2015-07-13 |
| 1346631165 | Northassist, LLC | Physician Assistant | 1202 E Arapaho Rd, Suite 122, Richardson, TX 75081-2477 | 2015-02-16 |
| 1578991022 | Tex Assist, LLC | Physician Assistant | 1105 Eastview Cir, Richardson, TX 75081-5431 | 2013-10-20 |
| 1174879159 | Breck James Wheelock | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2012-07-27 |
| 1659464691 | Donna Lynn Bailey | Physician Assistant | 204 Bridge Canyon Ct, Richardson, TX 75080-2600 | 2006-10-02 |
| 1699376459 | Oakmont Surgical Affiliates | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2020-11-06 |
| 1073114443 | Texassist Surgical Assist Staffing | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2020-11-03 |
| 1053927111 | Patient Plus | Physician Assistant | 1202 E Arapaho Rd Ste 122, Richardson, TX 75081-2400 | 2020-09-23 |
| 1447860531 | Complete Surgical Care LLC | Physician Assistant | 204 Bridge Canyon Ct, Richardson, TX 75080-2600 | 2020-08-04 |
| Find all providers in RICHARDSON | ||||
| City | RICHARDSON |
| Zip Code | 75081 |
Please comment or provide details below to improve the information on BLUEJACK SURGICAL AFFILIATES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.