Provider Demographics
NPI:1649793613
Name:BAYLOR SURGICARE AT BLUE STAR, LLC
Entity type:Organization
Organization Name:BAYLOR SURGICARE AT BLUE STAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-815-3665
Mailing Address - Street 1:3800 GAYLORD PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9419
Mailing Address - Country:US
Mailing Address - Phone:972-668-5911
Mailing Address - Fax:972-692-6445
Practice Address - Street 1:3800 GAYLORD PARKWAY
Practice Address - Street 2:SUITE 410
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-668-5911
Practice Address - Fax:972-692-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical