Northeast Texas Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

008678 Issued in TX

Legal business name

NORTHEAST TEXAS SURGERY CENTER

Practice address

1902 Moores LN
Suite B
Texarkana, TX 75503-4610

Phone

(903) 792-2108

Fax

(903) 792-0606

NPI assigned

Dec 16, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Penny Jo Burnham, RN

Title

ASC Director

Phone

(903) 792-2108

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Northeast Texas Surgical Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1063498657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 MOORES LN",
            "address_2": "SUITE B",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034610",
            "telephone_number": "903-792-2108",
            "fax_number": "903-792-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 MOORES LN",
            "address_2": "SUITE B",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034610",
            "telephone_number": "903-792-2108",
            "fax_number": "903-792-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST TEXAS SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "BURNHAM",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "ASC DIRECTOR",
        "authorized_official_telephone_number": "903-792-2108",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "008109",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "008678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BCBS",
            "identifier": "10517",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX BCBS ID",
            "identifier": "HH1366",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126632128",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176285801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Texas Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.