Provider Demographics
NPI:1932104064
Name:NORTHSTAR SURGICAL CENTER LP
Entity Type:Organization
Organization Name:NORTHSTAR SURGICAL CENTER LP
Other - Org Name:NORTHSTAR SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADLERZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:4640 N LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-2423
Mailing Address - Country:US
Mailing Address - Phone:806-761-4880
Mailing Address - Fax:806-749-5944
Practice Address - Street 1:4640 N LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2423
Practice Address - Country:US
Practice Address - Phone:806-761-4880
Practice Address - Fax:806-749-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXASC007292261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1557OtherBLUE CROSS/BLUE SHIELD
TX142949003Medicaid
TX49-0005111OtherRAILROAD MEDICARE
TX142949003Medicaid