| NPI | 1104875624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN B STACKS President 903-870-4609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2008-07-17 |