Provider Demographics
NPI:1184689010
Name:PARK CITIES SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PARK CITIES SURGERY CENTER, LLC
Other - Org Name:PARK CITIES SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:6901 SNIDER PLZ
Mailing Address - Street 2:STE 300
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5650
Mailing Address - Country:US
Mailing Address - Phone:214-706-6901
Mailing Address - Fax:214-706-6914
Practice Address - Street 1:6901 SNIDER PLZ
Practice Address - Street 2:STE 300
Practice Address - City:UNIVERSITY PARK
Practice Address - State:TX
Practice Address - Zip Code:75205-5650
Practice Address - Country:US
Practice Address - Phone:214-706-6901
Practice Address - Fax:214-706-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007967261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1766974Medicaid
TX1766974Medicaid
TX45C0001615Medicare Oscar/Certification