Healthcare Provider Details

I. General information

NPI: 1316214158
Provider Name (Legal Business Name): PLACE OF THE PEOPLE AMBULATORY SURGERY CENTER LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 MEDICAL LOOP UNIT 4A
LAREDO TX
78045-6671
US

IV. Provider business mailing address

10410 MEDICAL LOOP UNIT 4A
LAREDO TX
78045-6671
US

V. Phone/Fax

Practice location:
  • Phone: 956-462-6038
  • Fax: 956-462-6039
Mailing address:
  • Phone: 956-462-6038
  • Fax: 956-462-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number130147
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE8825
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberK6333
License Number StateTX

VIII. Authorized Official

Name: MRS. NAOMI SLOMAN-MOLL
Title or Position: CFO
Credential:
Phone: 956-794-8870