Provider Demographics
NPI:1770581373
Name:GALLAGHER PARK SURGICENTER LTD
Entity type:Organization
Organization Name:GALLAGHER PARK SURGICENTER LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-813-3377
Mailing Address - Street 1:300 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7388
Mailing Address - Country:US
Mailing Address - Phone:903-813-3377
Mailing Address - Fax:903-868-3748
Practice Address - Street 1:300 N HIGHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7388
Practice Address - Country:US
Practice Address - Phone:903-813-3377
Practice Address - Fax:903-868-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007871261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1380OtherBCBS PROVIDER #
TX5217068OtherAETNA PROVIDER #
TX10659955587OtherHUMANA PROVIDER #
TX1497604OtherHMO BLUE PROVIDER #
TX2517739OtherAETNA HMO PROVIDER #
TX155561701Medicaid
TX6850045OtherUHC PROVIDER #
TX922866OtherFIRST HEALTH PROV #
TX950014214OtherBLUE LINK PROVIDER #
TX155561701Medicaid
TXHH1380OtherBCBS PROVIDER #
TX5217068OtherAETNA PROVIDER #
TX490005313Medicare ID - Type UnspecifiedMEDICARE RAILROAD PROV#