Provider Demographics
NPI:1013914316
Name:BURLINGAME SURGICAL CENTER, PA
Entity Type:Organization
Organization Name:BURLINGAME SURGICAL CENTER, PA
Other - Org Name:NORTH TRAVIS AMBULATORY SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-892-3282
Mailing Address - Street 1:1303 N TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5138
Mailing Address - Country:US
Mailing Address - Phone:903-892-3282
Mailing Address - Fax:903-892-8591
Practice Address - Street 1:1325 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5138
Practice Address - Country:US
Practice Address - Phone:903-892-3282
Practice Address - Fax:903-892-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007160261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0879777-01Medicaid
TX0879777-01Medicaid