Provider Demographics
NPI:1639561640
Name:BLUEBONNET SURGERY PAVILION LLC
Entity Type:Organization
Organization Name:BLUEBONNET SURGERY PAVILION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-328-8686
Mailing Address - Street 1:1324 BROWN ST
Mailing Address - Street 2:600
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1421
Mailing Address - Country:US
Mailing Address - Phone:972-937-4000
Mailing Address - Fax:972-937-4001
Practice Address - Street 1:1324 BROWN ST
Practice Address - Street 2:600
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1421
Practice Address - Country:US
Practice Address - Phone:972-937-4000
Practice Address - Fax:972-937-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical