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General NPI Number Information
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NPI Number | 1417760489
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Entity Type | Organization
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Legal Business Name | SERL INDIANA ACQUISITION PARTNERS LLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 7007 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79413-6113
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Country | US
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Telephone | 806-701-4141
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 92535
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City | SOUTHLAKE
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State | TX
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Zip | 76092-0535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JULIE RADLEY
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Credential |
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Telephone | 713-591-2256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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