CCST Associates PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

J8654 Issued in TX

Legal business name

CCST ASSOCIATES PLLC

Practice address

221 W Colorado Blvd
Suite 100
Dallas, TX 75208

Phone

(214) 943-8605

Fax

(214) 941-3076

NPI assigned

Sep 22, 2006

Last updated

Oct 17, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alicia J Mangram, M.D.NPI 1972575504

Title

Trauma Surgeon

Phone

(214) 943-8605

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alicia Mangram, MD

  • Surgical Critical Care Physician
  • Phoenix, AZ
  • NPI 1972575504
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1023117157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 W COLORADO BLVD",
            "address_2": "SUITE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75208",
            "telephone_number": "214-943-8605",
            "fax_number": "214-941-3076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 W COLORADO BLVD",
            "address_2": "SUITE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75208",
            "telephone_number": "214-943-8605",
            "fax_number": "214-941-3076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCST ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "MANGRAM",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "TRAUMA SURGEON",
        "authorized_official_telephone_number": "214-943-8605",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "J8654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144729404",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Dallas, TX
• Providers in Dallas, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.