Provider Demographics
NPI:1750474516
Name:NORTHWEST TEXAS SURGICAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:NORTHWEST TEXAS SURGICAL HOSPITAL, LLC
Other - Org Name:NORTHWEST TEXAS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-359-7999
Mailing Address - Street 1:PO BOX 50360
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0360
Mailing Address - Country:US
Mailing Address - Phone:806-351-1560
Mailing Address - Fax:806-351-0343
Practice Address - Street 1:3501 SONCY ROAD
Practice Address - Street 2:SUITE #118
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118
Practice Address - Country:US
Practice Address - Phone:806-359-7999
Practice Address - Fax:806-355-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C17SOtherBLUE CROSS & BLUE SHIELD
TX142537301Medicaid
TXCJ3394Medicare PIN
TX450796Medicare UPIN
TX00C17SOtherBLUE CROSS & BLUE SHIELD