Provider Demographics
NPI:1235510090
Name:HERITAGE PARK SURGICAL HOSPITAL LLC
Entity Type:Organization
Organization Name:HERITAGE PARK SURGICAL HOSPITAL LLC
Other - Org Name:BAYLOR SCOTT & WHITE SURGICAL HOSPITAL AT SHERMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/ AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-815-3665
Mailing Address - Street 1:3601 N CALAIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1785
Mailing Address - Country:US
Mailing Address - Phone:903-813-3700
Mailing Address - Fax:903-813-3701
Practice Address - Street 1:3601 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:903-870-0999
Practice Address - Fax:903-813-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100320OtherSTATE LICENSE
TX100320OtherSTATE LICENSE