NPI | 1417957796 |
---|---|
Entity Type | Organization |
Authorized Contact | ANDY WALDO Administrator 318-327-3105 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
Additional Taxonomies | 261QE0800X Clinic/Center, Endoscopy (Licence: LA 38) |
Enumeration Date | 2005-07-28 |
Last Update Date | 2025-01-10 |