Provider Demographics
NPI:1962626523
Name:CALLOWAY CREEK SURGERY CENTER LP
Entity Type:Organization
Organization Name:CALLOWAY CREEK SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:4300 CITY POINT DR
Mailing Address - Street 2:STE 100
Mailing Address - City:N. RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180
Mailing Address - Country:US
Mailing Address - Phone:817-548-4000
Mailing Address - Fax:817-548-4001
Practice Address - Street 1:4300 CITY POINT DR
Practice Address - Street 2:STE 100
Practice Address - City:N. RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-548-4000
Practice Address - Fax:817-548-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008592261QA1903X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194198101Medicaid
TX194198101Medicaid