Healthcare Provider Details

I. General information

NPI: 1417909508
Provider Name (Legal Business Name): GASLIGHT AMBULATORY SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 GASLIGHT MEDICAL PKWY
LUFKIN TX
75904-3150
US

IV. Provider business mailing address

117 GASLIGHT MEDICAL PKWY
LUFKIN TX
75904-3150
US

V. Phone/Fax

Practice location:
  • Phone: 936-631-6000
  • Fax: 936-631-6082
Mailing address:
  • Phone: 936-631-6000
  • Fax: 936-631-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number008193
License Number StateTX

VIII. Authorized Official

Name: REBECCA HURLEY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 214-473-7000