Provider Demographics
NPI:1275536328
Name:BELLAIRE OUTPATIENT SURGERY CENTER, LLP
Entity Type:Organization
Organization Name:BELLAIRE OUTPATIENT SURGERY CENTER, LLP
Other - Org Name:BAYLOR SCOTT & WHITE SURGICARE - OAKMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:7200 OAKMONT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3902
Mailing Address - Country:US
Mailing Address - Phone:817-732-3300
Mailing Address - Fax:817-732-0110
Practice Address - Street 1:7200 OAKMONT BOULEVARD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3902
Practice Address - Country:US
Practice Address - Phone:817-732-3300
Practice Address - Fax:817-732-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007890261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
202158900OtherUS DEPT OF LABOR
HH1393OtherBCBS
TX163516101Medicaid
TXP00090576OtherRAILROAD MEDICARE
HH1393OtherBCBS
ASC153Medicare PIN