Provider Demographics
NPI:1972562940
Name:UROLOGY SURGERY CENTER OF TEXARKANA
Entity Type:Organization
Organization Name:UROLOGY SURGERY CENTER OF TEXARKANA
Other - Org Name:SPECIALTY DAY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VONGPHANET
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:SIHARATH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:903-792-7515
Mailing Address - Street 1:1902 MOORES LN
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4610
Mailing Address - Country:US
Mailing Address - Phone:903-792-7515
Mailing Address - Fax:903-793-8225
Practice Address - Street 1:1902 MOORES LN
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4610
Practice Address - Country:US
Practice Address - Phone:903-792-7515
Practice Address - Fax:903-793-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008308261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical