Provider Demographics
NPI:1588190904
Name:TEXAS HEALTH HUGULEY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:TEXAS HEALTH HUGULEY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO TEXAS HEALTH HUGULEY
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-551-2704
Mailing Address - Street 1:12001 SOUTH FWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7208
Mailing Address - Country:US
Mailing Address - Phone:817-615-4400
Mailing Address - Fax:817-615-4420
Practice Address - Street 1:12001 SOUTH FWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7208
Practice Address - Country:US
Practice Address - Phone:817-615-4400
Practice Address - Fax:817-615-4420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS HEALTH HUGULEY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-04
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX404514801Medicaid