=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912948845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS SURGICAL HOSPITALS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 04/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6819 PLUM CREEK DR
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79124-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-354-6100
-----------------------------------------------------
Fax | 806-354-6101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6819 PLUM CREEK DR
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79124-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-354-6100
-----------------------------------------------------
Fax | 806-354-6101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. TODD GREENE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-212-0244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 008529
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------