Provider Demographics
NPI:1235332933
Name:VBOA ASC PARTNERS LLC
Entity Type:Organization
Organization Name:VBOA ASC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / 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 1:15305 DALLAS PKWY STE 1600
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6491
Mailing Address - Country:US
Mailing Address - Phone:972-763-3893
Mailing Address - Fax:972-692-6745
Practice Address - Street 1:5700 NORTH EXPRESSWAY 77/83
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4353
Practice Address - Country:US
Practice Address - Phone:956-698-4870
Practice Address - Fax:956-698-4927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY BAPTIST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-08
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ASC359Medicare PIN