Healthcare Provider Details

I. General information

NPI: 1962568725
Provider Name (Legal Business Name): BRECKENRIDGE SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/21/2022
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E PRESIDENT GEORGE BUSH HWY SUITE 100
RICHARDSON TX
75082-3566
US

IV. Provider business mailing address

3201 E PRESIDENT GEORGE BUSH HWY SUITE 100
RICHARDSON TX
75082-3566
US

V. Phone/Fax

Practice location:
  • Phone: 972-470-5859
  • Fax: 972-470-5861
Mailing address:
  • Phone: 972-470-5000
  • Fax: 972-470-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS MAMIE SUE CLARK
Title or Position: OR DIRECTOR
Credential:
Phone: 972-470-5859