Provider Demographics
NPI:1356542419
Name:WINDHAVEN SURGERY CENTER, LLC
Entity type:Organization
Organization Name:WINDHAVEN SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRERUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-875-7336
Mailing Address - Street 1:6160 WINDHAVEN PKWY
Mailing Address - Street 2:STE 220
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:214-707-0985
Mailing Address - Fax:888-525-3558
Practice Address - Street 1:6160 WINDHAVEN PKWY
Practice Address - Street 2:STE 220
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:214-707-0985
Practice Address - Fax:888-525-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPP #08498261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC356Medicare PIN