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General NPI Number Information
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NPI Number | 1306830195
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Entity Type | Organization
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Legal Business Name | FOUNDATION SURGERY AFFILIATES OF HUNTSVILLE
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 643 IH 45 S
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City | HUNTSVILLE
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State | TX
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Zip | 77340-6434
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Country | US
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Telephone | 936-291-3200
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Fax | 936-291-9061
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Provider Business Mailing Address
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Address Line | 643 IH 45 S
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City | HUNTSVILLE
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State | TX
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Zip | 77340-6434
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Country | US
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Telephone | 936-291-3200
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Fax | 936-291-9061
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TAVA FOGLE
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Credential | RN, BSN
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Telephone | 936-291-3200
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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 | 007171
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License Number State | TX
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