Provider Demographics
NPI:1275647901
Name:PERMIAN BASIN SURGICAL CARE CENTER, LLC
Entity Type:Organization
Organization Name:PERMIAN BASIN SURGICAL CARE CENTER, LLC
Other - Org Name:VISTA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:4200 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4822
Mailing Address - Country:US
Mailing Address - Phone:432-520-5888
Mailing Address - Fax:432-520-5889
Practice Address - Street 1:4200 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703
Practice Address - Country:US
Practice Address - Phone:432-520-5888
Practice Address - Fax:432-520-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007919261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC159Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER