Provider Demographics
NPI:1336839893
Name:SAN-SUN 2014 SERIES LLC
Entity Type:Organization
Organization Name:SAN-SUN 2014 SERIES LLC
Other - Org Name:TEXOMA DAY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-850-6398
Mailing Address - Street 1:1511 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4430
Mailing Address - Country:US
Mailing Address - Phone:940-767-0818
Mailing Address - Fax:940-763-8096
Practice Address - Street 1:1815 TENTH STREET
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5054
Practice Address - Country:US
Practice Address - Phone:940-767-0818
Practice Address - Fax:940-763-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical