Provider Demographics
NPI:1962772871
Name:SURGERY CENTER OF NORTHEAST TEXAS LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF NORTHEAST TEXAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-240-3741
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:1902 MOORES LN
Practice Address - Street 2:SUITE, B
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4610
Practice Address - Country:US
Practice Address - Phone:903-792-2108
Practice Address - Fax:903-792-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical