Basic Information
| Provider Information | |||||||||
| NPI: | 1306920509 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEWISVILLE SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9720 COIT RD | ||||||||
| Address2: | STE. 220 # 336 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750255833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724200023 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Practice Location | |||||||||
| Address1: | 591 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750573628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724200023 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | LIPTON | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9724200023 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | HH1525 | 01 | TX | BCBS | OTHER | 45C1237 | 01 | TX | MEDICARE | OTHER |