Provider Demographics
NPI:1134450489
Name:FOUNDATION SURGICAL HOSPITAL OF GRAYSON COUNTY LLC
Entity type:Organization
Organization Name:FOUNDATION SURGICAL HOSPITAL OF GRAYSON COUNTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-936-8213
Mailing Address - Street 1:14000 N PORTLAND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4003
Mailing Address - Country:US
Mailing Address - Phone:405-936-8213
Mailing Address - Fax:405-936-8313
Practice Address - Street 1:3601 N CALAIS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1785
Practice Address - Country:US
Practice Address - Phone:405-936-8213
Practice Address - Fax:405-936-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital