Provider Demographics
NPI:1992008965
Name:BAYLOR SURGICARE AT ENNIS LLC
Entity Type:Organization
Organization Name:BAYLOR SURGICARE AT ENNIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:2200 PHYSICANS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-6247
Mailing Address - Country:US
Mailing Address - Phone:972-875-5538
Mailing Address - Fax:972-875-8530
Practice Address - Street 1:2200 PHYSICANS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6247
Practice Address - Country:US
Practice Address - Phone:972-875-5538
Practice Address - Fax:972-875-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008756261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00936810OtherRAILROAD MEDICARE
TXASC428Medicare PIN