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NPI Code Detail

MEDICARE: FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC

MEDICARE: FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center007238TX

General Provider Information

NPI Number : 1649252883
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC
Provider Business Mailing Address
First Line : 3610 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2539
Country : US
Telephone Number : 936-560-9599
Fax Number : 936-560-6933
Provider Business Practice Location Address
First Line : 3610 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2539
Country : US
Telephone Number : 936-560-9599
Fax Number : 936-560-6933
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : CARAH GODINEZ
Credential :
Telephone Number : 817-705-6517
Provider Enumeration Date : 11/15/2005
Last Update Date : 01/21/2026

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Directions to “FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC ” Practice Location

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