| NPI | 1710630199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK DEMONE EVANS Managing Member 817-637-0135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound |
| 208600000X Surgery | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-02-08 |