Provider Demographics
NPI:1790822278
Name:SURGERY CENTER OF WAXAHACHIE LP
Entity Type:Organization
Organization Name:SURGERY CENTER OF WAXAHACHIE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-387-0575
Mailing Address - Street 1:106 LUCAS STREET
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2202
Mailing Address - Country:US
Mailing Address - Phone:913-314-9193
Mailing Address - Fax:
Practice Address - Street 1:106 LUCAS STREET
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2202
Practice Address - Country:US
Practice Address - Phone:913-314-9193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190994701Medicaid
TXHH156AOtherBCBS TX
TXASC349Medicare PIN