Basic Information
| Provider Information | |||||||||
| NPI: | 1942570502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARK TEN SURGICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14000 N PORTLAND AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731344003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056081766 | ||||||||
| FaxNumber: | 4056081866 | ||||||||
| Practice Location | |||||||||
| Address1: | 15775 PARK TEN PL | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770845153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816472300 | ||||||||
| FaxNumber: | 2815507888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | HENSLEY | ||||||||
| AuthorizedOfficialFirstName: | SUZY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4056081766 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.