Provider Demographics
NPI:1205146404
Name:SURGERY CENTER OF CROCKETT, LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF CROCKETT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-307-9191
Mailing Address - Street 1:200 RENAISSANCE WAY
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1814
Mailing Address - Country:US
Mailing Address - Phone:936-307-9191
Mailing Address - Fax:936-544-7401
Practice Address - Street 1:200 RENAISSANCE WAY
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1814
Practice Address - Country:US
Practice Address - Phone:936-307-9191
Practice Address - Fax:936-544-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical