Provider Demographics
NPI:1336246099
Name:VALLEY BAPTIST AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:VALLEY BAPTIST AMBULATORY SURGERY CENTER, LLC
Other - Org Name:PLATINUM SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER/CLAIMS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:956-389-6000
Mailing Address - Street 1:2220 PEASE ST
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8308
Mailing Address - Country:US
Mailing Address - Phone:956-389-6000
Mailing Address - Fax:956-389-6015
Practice Address - Street 1:2220 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8308
Practice Address - Country:US
Practice Address - Phone:956-389-6000
Practice Address - Fax:956-389-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000380261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087947002Medicaid
TX0879470-01Medicaid
TX490004156OtherMEDICARE RAILROAD
TX087947002Medicaid