Healthcare Provider Details

I. General information

NPI: 1235424433
Provider Name (Legal Business Name): SURGEONS CHOICE SURGICAL FIRST ASSISTANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GLENCREST DR
CEDAR HILL TX
75104-2926
US

IV. Provider business mailing address

1000 GLENCREST DR
CEDAR HILL TX
75104-2926
US

V. Phone/Fax

Practice location:
  • Phone: 214-378-9898
  • Fax: 214-378-9888
Mailing address:
  • Phone: 214-378-9898
  • Fax: 214-378-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number577126
License Number StateTX

VIII. Authorized Official

Name: ANGELA JONES
Title or Position: OFFICE MANAGER
Credential: CPC
Phone: 214-378-9898