Provider Demographics
NPI:1841295425
Name:CROSS TIMBERS SURGERY CENTER, LLC
Entity type:Organization
Organization Name:CROSS TIMBERS SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-265-4844
Mailing Address - Street 1:1001 N WALDROP DR
Mailing Address - Street 2:STE 705
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4704
Mailing Address - Country:US
Mailing Address - Phone:817-265-4844
Mailing Address - Fax:817-265-1449
Practice Address - Street 1:1001 N WALDROP DR
Practice Address - Street 2:STE 705
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4704
Practice Address - Country:US
Practice Address - Phone:817-265-4844
Practice Address - Fax:817-265-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007788261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148515301Medicaid
TXHH1568OtherBLUE CROSS BLUE SHIELD
TX451294Medicare ID - Type UnspecifiedMEDICARE ID NUM
TXHH1568OtherBLUE CROSS BLUE SHIELD