NPIMap

Organization Active NPI

Texoma Outpatient Surgery Center, Inc.

  • Certified Registered Nurse Anesthetist
  • Wichita Falls, TX
National Provider Identifier
1063517316
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
317 Issued in TX
Legal business name
TEXOMA OUTPATIENT SURGERY CENTER, INC.
Practice address
1712 11TH St
Wichita Falls, TX 76301-5020
Phone
(940) 723-2499
Fax
(940) 723-2497
NPI assigned
Sep 13, 2006
Last updated
Jul 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Authorized official

Name
Tracy Youngblood
Title
RN/Administrator
Phone
(940) 723-2499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X 317 TX Primary

Addresses

Primary practice location

1712 11TH St
Wichita Falls, TX 76301-5020

Mailing address

1712 11TH St
Wichita Falls, TX 76301-5020
Phone (940) 723-2499

Other identifiers 1

IdentifierTypeStateIssuer
00C10NOtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081118000609 TX Part B Supplier - Clinic/Group Practice 0749340966 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Wichita Falls, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1712 11th St
Wichita Falls, TX 76301
Phone (940) 723-2499

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1063517316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 11TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015020",
            "telephone_number": "940-723-2499",
            "fax_number": "940-723-2497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 11TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015020",
            "telephone_number": "940-723-2499",
            "fax_number": "940-723-2497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXOMA OUTPATIENT SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "YOUNGBLOOD",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "RN/ADMINISTRATOR",
        "authorized_official_telephone_number": "940-723-2499"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00C10N",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.