MEDICARE: COLLIN COUNTY ASC, LP

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1417304171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIN COUNTY ASC, LP

Provider Business Mailing Address
First Line	:	DEPT# 6029, PO BOX 4417
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4417
Country	:	US
Telephone Number	:	610-644-8900
Fax Number	:	484-924-0053

Provider Business Practice Location Address
First Line	:	5085 W PARK BLVD
Second Line	:	SUITE 180B
City	:	PLANO
State	:	TX
Zip	:	75093-2593
Country	:	US
Telephone Number	:	713-812-7586
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KELLY MARIE BEMIS
Credential	:
Telephone Number	:	858-722-2358

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	11/09/2023

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