Provider Demographics
NPI:1326062910
Name:HILLCREST SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:HILLCREST SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSWALT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-202-8599
Mailing Address - Street 1:3000 HERRING
Mailing Address - Street 2:PO BOX 8561
Mailing Address - City:WACO
Mailing Address - State:TN
Mailing Address - Zip Code:76714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 HERRING
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708
Practice Address - Country:US
Practice Address - Phone:254-202-8599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER