1114236304 NPI number — GRAYSON COUNTY PHYSICIAN'S PROPERTY, LLC

Table of content: (NPI 1114236304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114236304 NPI number — GRAYSON COUNTY PHYSICIAN'S PROPERTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAYSON COUNTY PHYSICIAN'S PROPERTY, LLC
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:
HERITAGE PARK SURGICAL HOSPITAL
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:
1114236304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14000 N. PORTLAND AVEUE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-608-1766
Provider Business Mailing Address Fax Number:
405-608-1866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 CALAIS STREET
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:
75090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-813-3700
Provider Business Practice Location Address Fax Number:
903-813-3701
Provider Enumeration Date:
10/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HENSLEY
Authorized Official First Name:
SUZY
Authorized Official Middle Name:
Authorized Official Title or Position:
LEGAL ASSISTANT
Authorized Official Telephone Number:
405-608-1766

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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