Provider Demographics
NPI:1780665653
Name:IRVING SURGERY CENTER, LTD.
Entity Type:Organization
Organization Name:IRVING SURGERY CENTER, LTD.
Other - Org Name:IRVING SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BLYTHE
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:972-445-1088
Mailing Address - Street 1:1430 N MACARTHUR BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-4409
Mailing Address - Country:US
Mailing Address - Phone:972-445-1088
Mailing Address - Fax:
Practice Address - Street 1:1430 N MACARTHUR BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4409
Practice Address - Country:US
Practice Address - Phone:972-445-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000287261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451171Medicare ID - Type Unspecified