Provider Demographics
NPI:1033223748
Name:PHYSICIANS SURGERY CENTER OF WACO
Entity Type:Organization
Organization Name:PHYSICIANS SURGERY CENTER OF WACO
Other - Org Name:WACO SURGICENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-723-1010
Mailing Address - Street 1:3323 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-6977
Mailing Address - Country:US
Mailing Address - Phone:903-723-1010
Mailing Address - Fax:
Practice Address - Street 1:2201 W LOOP 340
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6856
Practice Address - Country:US
Practice Address - Phone:254-772-6200
Practice Address - Fax:254-420-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008275261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181299201Medicaid
TX181299201Medicaid