Healthcare Provider Details

I. General information

NPI: 1811000755
Provider Name (Legal Business Name): SURGICAL ARTS SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6904 COLLEYVILLE BLVD SUITE 100
COLLEYVILLE TX
76034
US

IV. Provider business mailing address

6904 COLLEYVILLE BLVD SUITE 100
COLLEYVILLE TX
76034
US

V. Phone/Fax

Practice location:
  • Phone: 817-552-3223
  • Fax: 817-552-3224
Mailing address:
  • Phone: 817-552-3223
  • Fax: 817-552-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberJ2388
License Number StateTX

VIII. Authorized Official

Name: DR. CHRISTOPHER L TYE
Title or Position: PRINCIPAL
Credential: MD DDS
Phone: 817-552-3223