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General NPI Number Information
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NPI Number | 1336103605
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE SURGICAL ASSOCIATES, LLP
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 7920 BELT LINE RD SUITE 310
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City | DALLAS
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State | TX
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Zip | 75254-8145
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Country | US
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Telephone | 972-331-8100
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Fax | 972-331-8110
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Provider Business Mailing Address
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Address Line | PO BOX 2316
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City | JACKSONVILLE
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State | TX
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Zip | 75766-0067
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Country | US
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Telephone | 903-586-6863
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Fax | 903-586-2122
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MALINDA KAY FELTS
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Credential |
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Telephone | 903-586-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | TX
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