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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