Basic Information
| Provider Information | |||||||||
| NPI: | 1528604675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGERY CENTER OF NORTH TEXAS, PLLC | ||||||||
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| Address1: | 2808 S INGRAM MILL RD BLDG B | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658044017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178892040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 STANDRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | ANNA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148311300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2019 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCARVILLE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4178892040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.