| NPI | 1154206126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLY INGRAM Administrator 267-455-4855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2026-03-30 |