Provider Demographics
NPI:1588039465
Name:SARATOGA SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:SARATOGA SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-452-5460
Mailing Address - Street 1:6214 SARATOGA BLVD BLDG 6
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3421
Mailing Address - Country:US
Mailing Address - Phone:361-452-5460
Mailing Address - Fax:361-452-5461
Practice Address - Street 1:6214 SARATOGA BLVD BLDG 6
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3421
Practice Address - Country:US
Practice Address - Phone:361-452-5460
Practice Address - Fax:361-452-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical