Basic Information
| Provider Information | |||||||||
| NPI: | 1649233180 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST PARK SURGERY CENTER, L.P. | ||||||||
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| OtherOrganizationName: | MEDICAL CITY SURGERY CENTER/MCKINNEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750691650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725471580 | ||||||||
| FaxNumber: | 9725478024 | ||||||||
| Practice Location | |||||||||
| Address1: | 4510 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750691650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725471580 | ||||||||
| FaxNumber: | 9725478024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | SWINNEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | GREGORY | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 9727892877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 8024 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 164934501 | 05 | TX | MEDICAID |