| NPI | 1003300104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE RYAN GILLIGAN Owner 214-536-6852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 282E00000X (Licence: TX M0731) |
| Additional Taxonomies | 261QC0050X Clinic/Center, Critical Access Hospital (Licence: TX M0731) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-06-21 |