| NPI | 1649870304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY EDWARDS Administrator 469-300-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208600000X Surgery |
| 2086S0120X Surgery, Pediatric Surgery | |
| 261QC0050X Clinic/Center, Critical Access Hospital | |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2025-02-04 |