Provider Demographics
NPI:1386032860
Name:FAITH SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:FAITH SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GATEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-450-0498
Mailing Address - Street 1:3716 STANDRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4146
Mailing Address - Country:US
Mailing Address - Phone:972-370-7200
Mailing Address - Fax:972-370-7208
Practice Address - Street 1:3716 STANDRIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4146
Practice Address - Country:US
Practice Address - Phone:972-370-7200
Practice Address - Fax:972-370-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130237261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263192Medicare PIN