1992761936 NPI number — ROCKWALL SURGERY CENTER LLP

Table of content: (NPI 1992761936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992761936 NPI number — ROCKWALL SURGERY CENTER LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKWALL 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:
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:
1992761936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 W. YELLOWJACKET LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKWALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-772-6166
Provider Business Mailing Address Fax Number:
972-772-6167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 YELLOW JACKET LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKWALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75087-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-772-6166
Provider Business Practice Location Address Fax Number:
972-772-6167
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
V
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
972-772-6166

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  008115 , 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: HHO46A . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com