NPIMap

Organization Active NPI

Head & Neck Surgical Associates

  • Otolaryngology Physician
  • Wichita Falls, TX
National Provider Identifier
1053304030
Registry record updated Mar 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
HEAD & NECK SURGICAL ASSOCIATES
Practice address
1 Burnside
Wichita Falls, TX 76310-1123
Phone
(940) 322-6953
Fax
(940) 767-9301
NPI assigned
Aug 25, 2005
Last updated
Mar 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2015

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

Authorized official

Name
Barry B Prestridge, MDNPI 1407849219
Title
President
Phone
(940) 322-6953

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

1 Burnside
Wichita Falls, TX 76310-1123

Mailing address

1 Burnside
Wichita Falls, TX 76310-1123
Phone (940) 322-6953

Other identifiers 1

IdentifierTypeStateIssuer
094815001MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040805001001 TX Part B Supplier - Clinic/Group Practice 8022089622 Receives reassigned benefits from 13 practitioners
Practice locations: Wichita Falls, TX

National Provider Directory

National Provider Directory

Locations

1 Burnside
Wichita Falls, TX 76310
Phone (940) 264-5500

1622 11th St
Wichita Falls, TX 76301
Phone (940) 322-6953

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1053304030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BURNSIDE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763101123",
            "telephone_number": "940-322-6953",
            "fax_number": "940-767-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BURNSIDE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763101123",
            "telephone_number": "940-322-6953",
            "fax_number": "940-767-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAD & NECK SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "PRESTRIDGE",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "940-322-6953",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094815001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.