1437155207 NPI number — TEXARKANA SURGERY CENTER LP

Table of content: (NPI 1437155207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437155207 NPI number — TEXARKANA SURGERY CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXARKANA 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:
1437155207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5404 SUMMERHILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-4607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-793-4872
Provider Business Mailing Address Fax Number:
903-794-6300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5404 SUMMERHILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-793-4872
Provider Business Practice Location Address Fax Number:
903-794-6300
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BALDOCK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
BOYD
Authorized Official Title or Position:
OFFICER AND AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-234-5935

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  006923 , 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: 085951401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH1367 . This is a "TEXAS BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10521 . This is a "ARKANSAS BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 136441128 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2317C . This is a "LOUISANA BCBS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 100755270-A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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