1013914316 NPI number — BURLINGAME SURGICAL CENTER, PA

Table of content: (NPI 1013914316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013914316 NPI number — BURLINGAME SURGICAL CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURLINGAME SURGICAL CENTER, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH TRAVIS AMBULATORY SURGICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013914316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1303 N TRAVIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75092-5138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-892-3282
Provider Business Mailing Address Fax Number:
903-892-8591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 N TRAVIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-5138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-892-3282
Provider Business Practice Location Address Fax Number:
903-892-8591
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRICE
Authorized Official First Name:
CLAIRE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADM/CLINICAL DIRECTOR
Authorized Official Telephone Number:
903-892-3282

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  007160 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0879777-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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