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General NPI Number Information
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NPI Number | 1386882587
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Entity Type | Organization
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Legal Business Name | BAYLOR SURGICARE AT GRANBURY LLC
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1717 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-5667
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Country | US
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Telephone | 817-579-8863
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Fax | 817-579-8872
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Provider Business Mailing Address
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Address Line | 1717 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-5667
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Country | US
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Telephone | 817-579-8863
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Fax | 817-579-8872
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DONITA FLEMING
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Credential |
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Telephone | 202-815-3665
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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 | 130006
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License Number State | TX
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