MEDICARE: NORTHWEST TEXAS SURGICAL HOSPITAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	000714	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003842212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST TEXAS SURGICAL HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	3501 S SONCY RD
Second Line	:	SUITE 118
City	:	AMARILLO
State	:	TX
Zip	:	79119-6405
Country	:	US
Telephone Number	:	806-359-7999
Fax Number	:	806-355-7598

Provider Business Practice Location Address
First Line	:	3501 S SONCY RD
Second Line	:	SUITE 118
City	:	AMARILLO
State	:	TX
Zip	:	79119-6405
Country	:	US
Telephone Number	:	806-359-7999
Fax Number	:	806-355-7598

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CLAY GEORGE WEISS
Credential	:
Telephone Number	:	806-354-7938

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	09/13/2010

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