Organization
BRECKENRIDGE SURGERY CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MAMIE SUE CLARK (OR DIRECTOR)
(972) 470-5859
Entity
Organization
Contact information
Practice address
3201 E PRESIDENT GEORGE BUSH HWY, SUITE 100, RICHARDSON, TX 75082-3566
(972) 470-5859
(972) 470-5861
Mailing address
3201 E PRESIDENT GEORGE BUSH HWY, SUITE 100, RICHARDSON, TX 75082-3566
(972) 470-5000
(972) 470-5861
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ASC239
PTAN
TX
01
—
HHO67A
BLUECROSS BLUE SHEILD
TX
Enumeration date
12/28/2006
Last updated
07/21/2022
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