MEDICARE: LEWISVILLE SURGERY CENTER, LLC

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
1	261QA1903X	Ambulatory Surgical Clinic/Center		TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	45C1237	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HH1525	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1306920509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWISVILLE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	9720 COIT RD
Second Line	:	STE. 220 # 336
City	:	PLANO
State	:	TX
Zip	:	75025-5833
Country	:	US
Telephone Number	:	972-420-0023
Fax Number	:	888-770-6360

Provider Business Practice Location Address
First Line	:	591 W MAIN ST
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-3628
Country	:	US
Telephone Number	:	972-420-0023
Fax Number	:	888-770-6360

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STUART LIPTON
Credential	:	M.D.
Telephone Number	:	972-420-0023

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/20/2015

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