Provider Demographics
NPI:1699519652
Name:PECAN GROVE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:PECAN GROVE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-893-6311
Mailing Address - Street 1:1111 SARA SWAMY DR STE B
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1779
Mailing Address - Country:US
Mailing Address - Phone:903-893-6311
Mailing Address - Fax:
Practice Address - Street 1:1111 SARA SWAMY DR STE B
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1779
Practice Address - Country:US
Practice Address - Phone:903-893-6311
Practice Address - Fax:903-870-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical