Organization
DEHAVEN CATARACT SURGICAL CENTER ,INC
Active
Other names
Dehaven Surgical Center, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA V. LOWNDES (FINANCIAL SERVICE MANAGER)
(903) 595-7510
Entity
Organization
Contact information
Practice address
1424 EAST FRONT, TYLER, TX 75702-8501
(903) 595-7510
(903) 526-5491
Mailing address
PO BOX 130639, TYLER, TX 75713-0639
(903) 595-7510
(903) 526-5491
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
000228
TX
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
000228
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085855701
—
TX
01
—
7170358
AETNA
TX
01
—
HH1281
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/07/2005
Last updated
03/08/2017
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