NORTHEAST TEXAS SURGERY CENTER NPI 1063498657

NPI Information

  • NPI: 1063498657
  • Provider Name: NORTHEAST TEXAS SURGERY CENTER
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • Doing Business As: NORTHEAST TEXAS SURGICAL CENTER
  • Address: 1902 MOORES LN
    SUITE B
    TEXARKANA, TX
    ZIP 75503
  • Phone: (903) 792-2108

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NPI Details

NORTHEAST TEXAS SURGERY CENTER is an ambulatory surgical clinic center in Texarkana, TX. NORTHEAST TEXAS SURGERY CENTER NPI is 1063498657. The provider is registered as an organization entity type.
The provider Is Doing Business As Northeast Texas Surgical Center.

The provider's business location address is:

1902 MOORES LN
SUITE B
TEXARKANA, TX
ZIP 75503-610
Phone: (903) 792-2108
Fax: (903) 792-0606

The provider's authorized official is Penny Jo Burnham .
The authorized official title is Asc Director and has the following contact phone number (903) 792-2108.

The enumeration date for this NPI number is 12/16/2005 and was last updated on 8/12/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory Surgical008109TEXASNo
2261QA1903XClinic/CenterAmbulatory Surgical008678TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
110517OTHERARKANSASAR BCBS
2126632128MEDICAIDARKANSAS
3176285801MEDICAIDTEXAS
4HH1366OTHERTEXASTX BCBS ID
5ASC231MEDICARE PINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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