1740228766 NPI number — THE SURGICAL & ENDOSCOPIC CENTER OF STEPHENVILLE

Table of content: (NPI 1740228766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740228766 NPI number — THE SURGICAL & ENDOSCOPIC CENTER OF STEPHENVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SURGICAL & ENDOSCOPIC CENTER OF STEPHENVILLE
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:
1740228766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 RIVER NORTH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEPHENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76401-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-918-2210
Provider Business Mailing Address Fax Number:
254-968-4204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 RIVER NORTH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEPHENVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76401-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-918-2210
Provider Business Practice Location Address Fax Number:
254-968-4204
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARTON
Authorized Official First Name:
SHERRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
254-968-7020

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  PENDING SURVEY , 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: P00367495 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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