Surgery Center of Crockett, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGERY CENTER OF CROCKETT, LLC

Doing business as

Renaissance Surgery Center

Practice address

200 Renaissance Way
Crockett, TX 75835-1814

Phone

(936) 307-9191

Fax

(936) 544-7401

NPI assigned

Oct 21, 2010

Last updated

Oct 21, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Patrick Walker, M.D.

Title

Medical Director

Phone

(936) 307-9191

Specialties & licenses 1

Addresses

Other names 1

• Renaissance Surgery Center Doing business as

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

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1205146404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RENAISSANCE WAY",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351814",
            "telephone_number": "936-307-9191",
            "fax_number": "936-544-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RENAISSANCE WAY",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351814",
            "telephone_number": "936-307-9191",
            "fax_number": "936-544-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF CROCKETT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "936-307-9191",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stanley Roger Speegle, MD
• Standley and Standley Enterprises LLC
• Cali Stapleton, NP
• Helen Joy Steel, LVN
• Susan Sweeney Studebaker, RNC, CNM
• Sophia Syverson
• Texas Family Doctor, PA
• Timberlands Healthcare, LLC (Timberlands Clinic)
• Timberlands Healthcare, LLC (Timberlands Hospital)
• Timberlands Healthcare, LLC (Timberlands Hospital)

• Ambulatory Surgical Clinic/Center in Crockett, TX
• Providers in Crockett, 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 Oct 21, 2010; 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.