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Organization
NORTHEAST TEXAS SURGERY CENTER
Active
Organization
NORTHEAST TEXAS SURGERY CENTER
Active
Other names
Northeast Texas Surgical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PENNY JO BURNHAM RN (ASC DIRECTOR)
(903) 792-2108
Entity
Organization
Contact information
Practice address
1902 MOORES LN, SUITE B, TEXARKANA, TX 75503-4610
(903) 792-2108
(903) 792-0606
Mailing address
1902 MOORES LN, SUITE B, TEXARKANA, TX 75503-4610
(903) 792-2108
(903) 792-0606
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
008109
TX
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
008678
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10517
AR BCBS
AR
05
—
126632128
—
AR
05
—
176285801
—
TX
01
—
HH1366
TX BCBS ID
TX
Enumeration date
12/16/2005
Last updated
08/12/2008
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