Provider Demographics
NPI:1093037152
Name:FOUNDATION SURGICAL HOSPITAL OF GRAYSON COUNTY LLC,
Entity Type:Organization
Organization Name:FOUNDATION SURGICAL HOSPITAL OF GRAYSON COUNTY LLC,
Other - Org Name:HERITAGE PARK SURGERY CENTER 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-936-8213
Mailing Address - Street 1:14000 N PORTLAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4004
Mailing Address - Country:US
Mailing Address - Phone:405-936-8213
Mailing Address - Fax:405-936-8313
Practice Address - Street 1:3603 N CALAIS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1785
Practice Address - Country:US
Practice Address - Phone:405-936-8213
Practice Address - Fax:405-936-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical