1275536328 NPI number — BELLAIRE OUTPATIENT SURGERY CENTER, LLP

Table of content: (NPI 1275536328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275536328 NPI number — BELLAIRE OUTPATIENT SURGERY CENTER, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLAIRE OUTPATIENT 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:
Provider Other Organization Name Type Code:
6
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:
1275536328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 OAKMONT BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76132-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-732-3300
Provider Business Mailing Address Fax Number:
817-732-0110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 OAKMONT BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76132-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-732-3300
Provider Business Practice Location Address Fax Number:
817-732-0110
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FLEMING
Authorized Official First Name:
DONITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
202-381-3665

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  007890 , 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: 202158900 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH1393 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00090576 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 163516101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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