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NPI Code Detail

MEDICARE: NORTHEAST TEXAS SURGERY CENTER

MEDICARE: NORTHEAST TEXAS SURGERY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center008109TX
2261QA1903XAmbulatory Surgical Clinic/Center008678TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110517OTHERARAR BCBS
2HH1366OTHERTXTX BCBS ID
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063498657
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST TEXAS SURGERY CENTER
Provider Business Mailing Address
First Line : 1902 MOORES LN
Second Line : SUITE B
City : TEXARKANA
State : TX
Zip : 75503-4610
Country : US
Telephone Number : 903-792-2108
Fax Number : 903-792-0606
Provider Business Practice Location Address
First Line : 1902 MOORES LN
Second Line : SUITE B
City : TEXARKANA
State : TX
Zip : 75503-4610
Country : US
Telephone Number : 903-792-2108
Fax Number : 903-792-0606
Authorized Official
Title or Position : ASC DIRECTOR
Name : MS. PENNY JO BURNHAM
Credential : RN
Telephone Number : 903-792-2108
Provider Enumeration Date : 12/16/2005
Last Update Date : 08/12/2008

Similar Medicare Providers

1558363507 — DR. CHRISTOPHER TODD PAYNE MD
Practice Location Address:
1902 MOORES LN
TEXARKANA, TX
75503-4610
Practice Phone: 903-792-7515
Practice Fax: 903-791-8645
1144222100 — DR. GLEN A ROUNTREE MD
Practice Location Address:
1902 MOORES LN
TEXARKANA, TX
75503-4610
Practice Phone: 903-792-7515
Practice Fax: 903-791-8645
1730183534 — DR. CORDELL L KLEIN MD
Practice Location Address:
1902 MOORES LN
TEXARKANA, TX
75503-4610
Practice Phone: 903-792-7515
Practice Fax: 903-791-8645
1538163910 — DR. JASON T PICKELMAN MD
Practice Location Address:
1902 MOORES LN
TEXARKANA, TX
75503-4610
Practice Phone: 903-792-7515
Practice Fax: 903-791-8645
1700868528 — COLLOM & CARNEY CLINIC ASSOCIATION
Practice Location Address:
1902 MOORES LN
TEXARKANA, TX
75503-4610
Practice Phone: 903-792-7515
Practice Fax:
1972562940 — UROLOGY SURGERY CENTER OF TEXARKANA
Practice Location Address:
1902 MOORES LN , SECOND FLOOR
TEXARKANA, TX
75503-4610
Practice Phone: 903-792-7515
Practice Fax: 903-793-8225

Directions to “NORTHEAST TEXAS SURGERY CENTER ” Practice Location

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