Provider Demographics
NPI:1902090822
Name:TURTLE CREEK SURGERY CENTER
Entity Type:Organization
Organization Name:TURTLE CREEK SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKOTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIGUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:903-526-8272
Mailing Address - Street 1:801 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1937
Mailing Address - Country:US
Mailing Address - Phone:903-526-8272
Mailing Address - Fax:903-526-5335
Practice Address - Street 1:801 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1937
Practice Address - Country:US
Practice Address - Phone:903-526-8272
Practice Address - Fax:903-526-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008054261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC210Medicare UPIN