Provider Demographics
NPI:1811000755
Name:SURGICAL ARTS SURGERY CENTER
Entity Type:Organization
Organization Name:SURGICAL ARTS SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:817-552-3223
Mailing Address - Street 1:6904 COLLEYVILLE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-552-3223
Mailing Address - Fax:817-552-3224
Practice Address - Street 1:6904 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-552-3223
Practice Address - Fax:817-552-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2388261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110918303Medicaid
TX110918303Medicaid
TXF31658Medicare ID - Type Unspecified