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General NPI Number Information
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NPI Number | 1346742277
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Entity Type | Organization
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Legal Business Name | TRI-STATE LITHOTRIPSY III LP
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 320 W FRANCIS AVE
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City | PAMPA
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State | TX
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Zip | 79065-6447
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Country | US
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Telephone | 806-669-3402
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Fax |
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Provider Business Mailing Address
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Address Line | 320 W FRANCIS AVE
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City | PAMPA
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State | TX
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Zip | 79065-6447
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Country | US
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Telephone | 806-669-3402
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. WAYNE BRUCE
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Credential |
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Telephone | 806-662-5898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QL0400X
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Taxonomy Name | Lithotripsy Clinic/Center
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License Number |
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License Number State |
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