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General NPI Number Information
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NPI Number | 1104623826
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Entity Type | Organization
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Legal Business Name | SURGICORE LLC
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 300 S NOLEN DR STE 160
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8054
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Country | US
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Telephone | 941-380-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 3207 OXFORD DR
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City | ROWLETT
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State | TX
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Zip | 75088-5938
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Country | US
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Telephone | 941-380-6513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSHUA STUART PUTTER
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Credential |
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Telephone | 941-380-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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