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General NPI Number Information
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NPI Number | 1164818191
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Entity Type | Organization
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Legal Business Name | WICHITA FALLS ENDOSCOPY CENTER, LP
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 1500 9TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4323
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Country | US
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Telephone | 940-761-9034
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Fax | 940-761-7510
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Provider Business Mailing Address
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Address Line | 1500 9TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4323
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Country | US
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Telephone | 940-761-9034
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Fax | 940-761-7510
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Authorized Official
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Title or Position | ADMIISTRATOR
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Name | MR. BRANDON BESHEAR
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Credential |
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Telephone | 940-761-9034
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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 | 8194
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License Number State | TX
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