Healthcare Provider Details

I. General information

NPI: 1396559951
Provider Name (Legal Business Name): METHODIST SURGERY CENTER - KELLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 KELLER PKWY
KELLER TX
76248-3615
US

IV. Provider business mailing address

1220 KELLER PKWY
KELLER TX
76248-3615
US

V. Phone/Fax

Practice location:
  • Phone: 682-593-1133
  • Fax: 817-380-1234
Mailing address:
  • Phone: 682-593-1133
  • Fax: 817-380-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER B. BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954