Provider Demographics
NPI:1669673828
Name:INTERVENTIONAL SURGICAL CARE, LP
Entity Type:Organization
Organization Name:INTERVENTIONAL SURGICAL CARE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-554-7733
Mailing Address - Street 1:1100 N EXPRESSWAY 83
Mailing Address - Street 2:STE 3
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-554-7733
Mailing Address - Fax:
Practice Address - Street 1:6501 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6627
Practice Address - Country:US
Practice Address - Phone:956-554-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007132261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC080Medicare ID - Type Unspecified