Provider Demographics
NPI:1609870336
Name:DESOTO SURGICARE PARTNERS, LTD
Entity Type:Organization
Organization Name:DESOTO SURGICARE PARTNERS, LTD
Other - Org Name:NORTH TEXAS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:7992 W VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3764
Mailing Address - Country:US
Mailing Address - Phone:972-283-2400
Mailing Address - Fax:972-283-0099
Practice Address - Street 1:7992 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3764
Practice Address - Country:US
Practice Address - Phone:972-283-2400
Practice Address - Fax:972-283-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000354261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN490003162OtherRAILROAD MEDICARE
TXZ04512051Medicaid
TXC0451205Medicare Oscar/Certification
TN490003162OtherRAILROAD MEDICARE