NORTHEAST TEXAS SURGICAL CENTER
NPI 1063498657
Clinic/Center - Ambulatory Surgical in Texarkana, TX

Q: What is Northeast Texas Surgery Center's NPI number?

The NPI number for Northeast Texas Surgery Center is 1063498657. It was assigned to this organization in the NPPES registry on December 16, 2005. The provider is doing business as Northeast Texas Surgical Center.

Q: What is Northeast Texas Surgery Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since December 16, 2005

1902 MOORES LN, SUITE B, TEXARKANA, TX 75503(903) 792-2108(903) 792-0606 Get Directions Write a Review

NPPES record last updated: August 12, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Northeast Texas Surgical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHEAST TEXAS SURGICAL CENTER (NPI 1063498657) is a healthcare organization registered as an ambulatory surgical in Texarkana, Texas and active in the NPI registry since December 2005. The organization lists Penny Jo Burnham, Asc Director, as its authorized official.

NPPES Registry Identity

NPI1063498657

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameNORTHEAST TEXAS SURGERY CENTER

Location Address1902 MOORES LN, SUITE BTexarkana, TX 75503-4610

Mailing Address1902 Moores Ln, Suite BTexarkana, TX 75503-4610 · (903) 792-2108 · Fax (903) 792-0606

Phone(903) 792-2108

Fax(903) 792-0606

Organization SubpartNo

Authorized OfficialPenny Jo BurnhamAsc Director · (903) 792-2108

Enumeration DateDecember 16, 2005

Last NPPES UpdateAugust 12, 2008

✔ NPI 1063498657 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

Licenses✔ Licensed in TX · 008678✔ Licensed in TX · 008109

1902 MOORES LN, Texarkana, TX 75503

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Other Names 1

Doing Business AsNortheast Texas Surgical Center

Other Identifiers 5

Other10517AR · Ar Bcbs

Medicaid126632128AR

Medicaid176285801TX

OtherHH1366TX · Tx Bcbs Id

Medicare PINASC231TX

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

UROLOGY ASSOCIATES OF TEXARKANA, PA

Specialist