Organization
NORTHEAST METHODIST SURGICARE, LTD
Active
Other names
Northeast Methodist Ambulatory Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY A CARR (CHIEF FINANCIAL OFFICER)
(210) 575-0238
Entity
Organization
Contact information
Practice address
12702 IH 35 NORTH, LIVE OAK, TX 78233-2609
(210) 575-5700
(210) 575-5701
Mailing address
12702 IH 35 NORTH, LIVE OAK, TX 78233-2609
(210) 575-5700
(210) 575-5701
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
000345
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49000335555
PALMETTO GBA
TX
01
—
HH1386
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/07/2006
Last updated
08/22/2020
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