Provider Demographics
NPI:1104623826
Name:SURGICORE LLC
Entity type:Organization
Organization Name:SURGICORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:PUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-380-6513
Mailing Address - Street 1:3207 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5938
Mailing Address - Country:US
Mailing Address - Phone:941-380-6513
Mailing Address - Fax:
Practice Address - Street 1:300 S NOLEN DR STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8053
Practice Address - Country:US
Practice Address - Phone:941-380-6513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical