Basic Information
| Provider Information | |||||||||
| NPI: | 1699006254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLOW CREEK SURGERY CENTER LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 WILLOW CREEK PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PALESTINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758014389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178892040 | ||||||||
| FaxNumber: | 4178872935 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 WILLOW CREEK PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PALESTINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758014389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178892040 | ||||||||
| FaxNumber: | 4178872935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | FULLER | ||||||||
| AuthorizedOfficialFirstName: | VERNESCIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9037292888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.