Provider Demographics
NPI:1497850648
Name:BAYSIDE A S C LP
Entity Type:Organization
Organization Name:BAYSIDE A S C LP
Other - Org Name:BAYSIDE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PATNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-487-6111
Mailing Address - Street 1:4001 PRESTON AVE
Mailing Address - Street 2:STE 175
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-2019
Mailing Address - Country:US
Mailing Address - Phone:281-487-6111
Mailing Address - Fax:281-487-6090
Practice Address - Street 1:4001 PRESTON AVE
Practice Address - Street 2:STE 175
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-2019
Practice Address - Country:US
Practice Address - Phone:281-487-6111
Practice Address - Fax:281-487-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008204261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167502701Medicaid
TX167502701Medicaid