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General NPI Number Information
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NPI Number | 1104644574
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Entity Type | Organization
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Legal Business Name | NORTHAVEN SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/05/2024
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Provider Practice Location Address
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Address Line | 2023 W MCDERMOTT DR STE 240
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City | ALLEN
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State | TX
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Zip | 75013-4679
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Country | US
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Telephone | 972-330-2696
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 MCDERMOTT RD STE 200-369
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City | PLANO
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State | TX
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Zip | 75025-7016
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Country | US
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Telephone | 972-999-1659
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Fax | 205-729-5887
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Authorized Official
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Title or Position | ADMIN
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Name | DAVID CLARK
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Credential |
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Telephone | 972-999-1659
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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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