Organization
TEXOMA OUTPATIENT SURGERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP W. KELLY M.D. (PRESIDENT/MEDICAL DIRECTOR)
(940) 723-2499
Entity
Organization
Contact information
Practice address
1712 11TH ST, WICHITA FALLS, TX 76301-5020
(940) 723-2499
(940) 723-2497
Mailing address
1712 11TH ST, WICHITA FALLS, TX 76301-5020
(940) 723-2499
(940) 723-2497
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
000317
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH1360
BCBS
TX
Enumeration date
08/09/2005
Last updated
07/17/2007
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