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General NPI Number Information
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NPI Number | 1932104064
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Entity Type | Organization
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Legal Business Name | NORTHSTAR SURGICAL CENTER LP
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 4640 N LOOP 289
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City | LUBBOCK
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State | TX
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Zip | 79416-2423
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Country | US
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Telephone | 806-761-4880
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Fax | 806-749-5944
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Provider Business Mailing Address
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Address Line | 4640 N LOOP 289
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City | LUBBOCK
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State | TX
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Zip | 79416-2423
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Country | US
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Telephone | 806-761-4880
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Fax | 806-749-5944
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | MR. CLIFFORD G ADLERZ
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Credential |
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Telephone | 615-234-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASC007292
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License Number State | TX
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