Provider Demographics
NPI:1598844367
Name:WACO SURGICAL CLINIC P A
Entity Type:Organization
Organization Name:WACO SURGICAL CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAYLAND
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-776-3188
Mailing Address - Street 1:6600 FISH POND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2581
Mailing Address - Country:US
Mailing Address - Phone:254-776-3188
Mailing Address - Fax:254-776-3607
Practice Address - Street 1:6600 FISH POND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2581
Practice Address - Country:US
Practice Address - Phone:254-776-3188
Practice Address - Fax:254-776-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B41SMedicare ID - Type Unspecified