Provider Demographics
NPI:1861418378
Name:MAPLEWOOD AMBULATORY SURGERY CENTER, INC.
Entity type:Organization
Organization Name:MAPLEWOOD AMBULATORY SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-696-8500
Mailing Address - Street 1:4301 MAPLEWOOD AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3879
Mailing Address - Country:US
Mailing Address - Phone:940-696-8548
Mailing Address - Fax:940-696-8546
Practice Address - Street 1:4301 MAPLEWOOD AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308
Practice Address - Country:US
Practice Address - Phone:940-696-8548
Practice Address - Fax:940-696-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000388261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0879546-01Medicaid
TX000388OtherTX STATE LICENSE #
TXASC029Medicare ID - Type UnspecifiedPROVIDER #