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NPI Code Detail

MEDICARE: TEXOMA SURGERY CENTER LLC

MEDICARE: TEXOMA 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1740671429
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEXOMA SURGERY CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 1011
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76307-1011
Country : US
Telephone Number : 940-264-2600
Fax Number : 940-264-2601
Provider Business Practice Location Address
First Line : 2200 KELL BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76309-4401
Country : US
Telephone Number : 940-264-2600
Fax Number : 940-264-2601
Authorized Official
Title or Position : PRESIDENT
Name : DR. PHILLIP J STEPHAN
Credential : M.D.
Telephone Number : 940-264-2600
Provider Enumeration Date : 02/17/2015
Last Update Date : 02/17/2015

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Directions to “TEXOMA SURGERY CENTER LLC ” Practice Location

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