Provider Demographics
NPI:1003839499
Name:VISTA SURGICAL CENTER WEST LLC
Entity Type:Organization
Organization Name:VISTA SURGICAL CENTER WEST LLC
Other - Org Name:PINEY POINT SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-4913
Mailing Address - Street 1:720 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2626
Mailing Address - Country:US
Mailing Address - Phone:615-550-4913
Mailing Address - Fax:615-550-4901
Practice Address - Street 1:2500 FONDREN RD
Practice Address - Street 2:SUITE 350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2308
Practice Address - Country:US
Practice Address - Phone:713-782-8279
Practice Address - Fax:713-782-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130046261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D0985134OtherCLIA
TXHH1377OtherBCBS #
TX151398801Medicaid
TXASC415Medicare PIN