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NPI Code Detail

MEDICARE: PARK TEN SURGICAL CENTER, LLC

MEDICARE: PARK TEN SURGICAL 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 : 1942570502
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK TEN SURGICAL CENTER, LLC
Provider Business Mailing Address
First Line : 14000 N PORTLAND AVE
Second Line : SUITE 203
City : OKLAHOMA CITY
State : OK
Zip : 73134-4003
Country : US
Telephone Number : 405-608-1766
Fax Number : 405-608-1866
Provider Business Practice Location Address
First Line : 15775 PARK TEN PL
Second Line :
City : HOUSTON
State : TX
Zip : 77084-5153
Country : US
Telephone Number : 281-647-2300
Fax Number : 281-550-7888
Authorized Official
Title or Position : EXECUTIVE ASSISTANT
Name : SUZY HENSLEY
Credential :
Telephone Number : 405-608-1766
Provider Enumeration Date : 01/12/2012
Last Update Date : 01/12/2012

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