NPIMap

Organization Active NPI

Texoma Outpatient Surgery Center, Inc.

  • Ambulatory Surgical Clinic/Center
  • Wichita Falls, TX
National Provider Identifier
1154322600
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
000317 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
Aug 9, 2005
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
Dr. Phillip W. Kelly, M.D.NPI 1285695601
Title
President/Medical Director
Phone
(940) 723-2499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 000317 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
HH1360OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Wichita Falls, TX
O20081202000597 TX Part B Supplier - Ambulatory Surgical Center 0749340966 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.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Texoma Outpatient Surgery Center IncCCN 45C0001176
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1154322600",
    "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": "2005-08-09",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "940-723-2499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "000317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "HH1360",
            "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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.