1104974310 NPI number — NORTHWEST SURGERY CENTER, LLP

Table of content: (NPI 1104974310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104974310 NPI number — NORTHWEST SURGERY CENTER, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST SURGERY CENTER, LLP
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:
NORTHWEST SURGERY CENTER
Provider Other Organization Name Type Code:
5
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:
1104974310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11111 RESEARCH BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-5264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-349-4000
Provider Business Mailing Address Fax Number:
512-349-4060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11111 RESEARCH BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759-5264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-349-4000
Provider Business Practice Location Address Fax Number:
512-349-4060
Provider Enumeration Date:
01/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORAN
Authorized Official First Name:
JENETHA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICER /AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
972-763-3893

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  008513 , 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)