Organization
CENTENNIAL ASC, LLC
Active
Other names
Baylor Surgicare at Centennial
Organization subpart
No
Provider details
NPI number
Authorized official
DONITA FLEMING (OFFICER / AUTHORIZED OFFICIAL)
(202) 815-3665
Entity
Organization
Contact information
Practice address
4401 COIT RD, SUITE 100, FRISCO, TX 75035
(214) 619-0120
(214) 619-0121
Mailing address
4401 COIT RD, SUITE 100, FRISCO, TX 75035-0500
(214) 619-0120
(214) 619-0121
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
008203
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH065A
BCBS OF TX
TX
01
—
P00617261
RAILROAD MEDICARE
TX
Enumeration date
03/01/2006
Last updated
09/18/2024
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