1750474516 NPI number — NORTHWEST TEXAS SURGICAL HOSPITAL, LLC

Table of content: (NPI 1750474516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750474516 NPI number — NORTHWEST TEXAS SURGICAL HOSPITAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST TEXAS SURGICAL HOSPITAL, 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:
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:
1750474516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79159-0360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-351-1560
Provider Business Mailing Address Fax Number:
806-351-0343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 SONCY ROAD
Provider Second Line Business Practice Location Address:
SUITE #118
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-359-7999
Provider Business Practice Location Address Fax Number:
806-355-7598
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
CLAY
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
806-359-7999

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)

  • Identifier: 00C17S . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 142537301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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