Provider Demographics
NPI:1396357372
Name:INNOVATIONS SURGERY CENTER, LP
Entity Type:Organization
Organization Name:INNOVATIONS SURGERY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATULIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-656-7753
Mailing Address - Street 1:300 WILLOW CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4433
Mailing Address - Country:US
Mailing Address - Phone:903-729-2888
Mailing Address - Fax:
Practice Address - Street 1:300 WILLOW CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4433
Practice Address - Country:US
Practice Address - Phone:903-729-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical