=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306804612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONE STAR ENDOSCOPY, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 BEAR CREEK PKWY
-----------------------------------------------------
City | KELLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76248-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-337-3671
-----------------------------------------------------
Fax | 817-337-3620
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 277417
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30384-7417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-337-3671
-----------------------------------------------------
Fax | 817-337-3620
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | MRS. KAREN PATRICIA SABLYAK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-589-9001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 8353
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------