Provider Demographics
NPI:1679804355
Name:LONESTAR AMBULATORY SURGICAL CENTER
Entity Type:Organization
Organization Name:LONESTAR AMBULATORY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIPS
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:LABOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-410-2030
Mailing Address - Street 1:2201 WESTGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8037
Mailing Address - Country:US
Mailing Address - Phone:817-416-7988
Mailing Address - Fax:817-416-7976
Practice Address - Street 1:2201 WESTGATE PLZ
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8037
Practice Address - Country:US
Practice Address - Phone:817-410-2030
Practice Address - Fax:817-865-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130049261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical