Provider Demographics
NPI:1295233658
Name:LEGENT OUTPATIENT SURGERY WESTOVER HILLS, LLC
Entity type:Organization
Organization Name:LEGENT OUTPATIENT SURGERY WESTOVER HILLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-421-1066
Mailing Address - Street 1:10622 STATE HIGHWAY 151 STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4729
Mailing Address - Country:US
Mailing Address - Phone:210-267-1589
Mailing Address - Fax:817-507-1800
Practice Address - Street 1:10622 STATE HIGHWAY 151 STE 114
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4729
Practice Address - Country:US
Practice Address - Phone:205-263-7863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical