Provider Demographics
NPI:1083299747
Name:IRVING SPECIALISTS SURGICAL CENTER LLC
Entity type:Organization
Organization Name:IRVING SPECIALISTS SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, ACCOUNTING & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-330-5747
Mailing Address - Street 1:1114 GA HIGHWAY 96 STE C1
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-4102
Mailing Address - Country:US
Mailing Address - Phone:478-330-5747
Mailing Address - Fax:478-310-3105
Practice Address - Street 1:6121 N HIGHWAY 161 STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2270
Practice Address - Country:US
Practice Address - Phone:478-330-5747
Practice Address - Fax:478-330-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical