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General NPI Number Information
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NPI Number | 1396357372
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Entity Type | Organization
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Legal Business Name | INNOVATIONS SURGERY CENTER, LP
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 300 WILLOW CREEK PKWY STE 100
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City | PALESTINE
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State | TX
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Zip | 75801-4433
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Country | US
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Telephone | 903-729-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 300 WILLOW CREEK PKWY STE 100
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City | PALESTINE
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State | TX
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Zip | 75801-4433
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Country | US
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Telephone | 903-729-2888
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Fax |
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | MELINDA MATULIA
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Credential |
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Telephone | 832-656-7753
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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 |
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License Number State |
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