Provider Demographics
NPI:1710595996
Name:LAREDO SURGICAL CENTER
Entity Type:Organization
Organization Name:LAREDO SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:281-777-0878
Mailing Address - Street 1:4606 PAYTON CHASE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3080
Mailing Address - Country:US
Mailing Address - Phone:281-777-0878
Mailing Address - Fax:
Practice Address - Street 1:10410 MEDICAL LOOP BLDG 4A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6672
Practice Address - Country:US
Practice Address - Phone:281-777-0878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory