Basic Information
| Provider Information | |||||||||
| NPI: | 1679804355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONESTAR AMBULATORY SURGICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 WESTGATE PLZ | ||||||||
| Address2: | |||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760518037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174167988 | ||||||||
| FaxNumber: | 8174167976 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 WESTGATE PLZ | ||||||||
| Address2: | |||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760518037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174102030 | ||||||||
| FaxNumber: | 8178651969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LABOR | ||||||||
| AuthorizedOfficialFirstName: | PHILLIPS | ||||||||
| AuthorizedOfficialMiddleName: | KIRK | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8174102030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 130049 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.