Basic Information
| Provider Information | |||||||||
| NPI: | 1114236304 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRAYSON COUNTY PHYSICIAN'S PROPERTY, LLC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HERITAGE PARK SURGICAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14000 N. PORTLAND AVEUE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731344004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056081766 | ||||||||
| FaxNumber: | 4056081866 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 CALAIS STREET | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038133700 | ||||||||
| FaxNumber: | 9038133701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | HENSLEY | ||||||||
| AuthorizedOfficialFirstName: | SUZY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | LEGAL ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4056081766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.