1962568725 NPI number — BRECKENRIDGE SURGERY CENTER LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962568725 NPI number — BRECKENRIDGE SURGERY CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRECKENRIDGE SURGERY CENTER LP
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:
Provider Other Organization Name Type Code:
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:
1962568725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 E PRESIDENT GEORGE BUSH HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75082-3566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-470-5000
Provider Business Mailing Address Fax Number:
972-470-5861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 E PRESIDENT GEORGE BUSH HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75082-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-470-5859
Provider Business Practice Location Address Fax Number:
972-470-5861
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
MAMIE
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
OR DIRECTOR
Authorized Official Telephone Number:
972-470-5859

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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: ASC239 . This is a "PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HHO67A . This is a "BLUECROSS BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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