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Organization
NORTHEAST BAPTIST SURGERY CENTER LLC
Active
Organization
NORTHEAST BAPTIST SURGERY CENTER LLC
Active
Other names
Village Specialty Surgical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MISTY DIANE WALTON (ADMINISTRATOR)
(210) 477-1788
Entity
Organization
Contact information
Practice address
8715 VILLAGE DR, SUITE 200, SAN ANTONIO, TX 78217
(210) 477-1775
(210) 477-1794
Mailing address
8715 VILLAGE DR, SUITE 200, SAN ANTONIO, TX 78217
(210) 477-1775
(210) 477-1794
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
000369
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087944701
—
TX
01
—
490003869
RAILROAD MEDICARE
TX
Enumeration date
07/01/2005
Last updated
11/05/2009
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