Provider Demographics
NPI:1902850506
Name:TEXAS HEALTH SURGERY CENTER PRESTON PLAZA, LLC
Entity Type:Organization
Organization Name:TEXAS HEALTH SURGERY CENTER PRESTON PLAZA, LLC
Other - Org Name:TEXAS HEALTH SURGERY CENTER PRESTON PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-780-3234
Mailing Address - Street 1:17950 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5793
Mailing Address - Country:US
Mailing Address - Phone:972-267-5400
Mailing Address - Fax:972-267-0499
Practice Address - Street 1:17950 PRESTON RD
Practice Address - Street 2:SUITE 75
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5793
Practice Address - Country:US
Practice Address - Phone:972-267-5400
Practice Address - Fax:972-267-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008328261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183618101Medicaid
P00324944OtherRR MEDICARE
TX183618101Medicaid