Healthcare Provider Details

I. General information

NPI: 1275958019
Provider Name (Legal Business Name): COTTONWOOD PROCEDURE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N MACARTHUR BLVD # 107
IRVING TX
75038-6497
US

IV. Provider business mailing address

4301 N MACARTHUR BLVD # 107
IRVING TX
75038-6497
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-5588
  • Fax:
Mailing address:
  • Phone: 972-255-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARY WON
Title or Position: MANAGER
Credential:
Phone: 972-255-5588