1770581373 NPI number — GALLAGHER PARK SURGICENTER LTD

Table of content: (NPI 1770581373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770581373 NPI number — GALLAGHER PARK SURGICENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GALLAGHER PARK SURGICENTER LTD
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:
1770581373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 N HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75092-7388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-813-3377
Provider Business Mailing Address Fax Number:
903-868-3748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-7388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-813-3377
Provider Business Practice Location Address Fax Number:
903-868-3748
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MULLENS
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
903-813-3377

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  007871 , 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: HH1380 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5217068 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10659955587 . This is a "HUMANA PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1497604 . This is a "HMO BLUE PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2517739 . This is a "AETNA HMO PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 155561701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6850045 . This is a "UHC PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 922866 . This is a "FIRST HEALTH PROV #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 950014214 . This is a "BLUE LINK PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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