Provider Demographics
NPI:1861494080
Name:ABILENE AMBULATORY SURGERY CENTER FOR PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:ABILENE AMBULATORY SURGERY CENTER FOR PAIN MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-794-5450
Mailing Address - Street 1:6399 DIRECTORS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5873
Mailing Address - Country:US
Mailing Address - Phone:325-794-5450
Mailing Address - Fax:325-794-5498
Practice Address - Street 1:6399 DIRECTORS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5873
Practice Address - Country:US
Practice Address - Phone:325-794-5450
Practice Address - Fax:325-794-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007313261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150030801Medicaid
TXASC125Medicare ID - Type UnspecifiedASC FOR PAIN MANAGEMENT
TX150030801Medicaid