Healthcare Provider Details

I. General information

NPI: 1194053769
Provider Name (Legal Business Name): SELECT OPERATIONS OF COLLEGE STATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 ROCK PRAIRIE RD
COLLEGE STATION TX
77845-8344
US

IV. Provider business mailing address

1601 MEDICAL CENTER DR SUITE 9
EDMOND OK
73034-6359
US

V. Phone/Fax

Practice location:
  • Phone: 888-753-6262
  • Fax: 888-753-6262
Mailing address:
  • Phone: 888-753-6262
  • Fax: 888-753-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC LINDSEY
Title or Position: MANAGER
Credential:
Phone: 888-753-6262