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General NPI Number Information
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NPI Number | 1477569069
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Entity Type | Organization
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Legal Business Name | FISH POND SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 601 W HWY 6 STE 109
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City | WACO
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State | TX
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Zip | 76710
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Country | US
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Telephone | 254-751-9836
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Fax | 254-751-9868
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Provider Business Mailing Address
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Address Line | 6600 FISH POND RD STE 104
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City | WACO
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State | TX
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Zip | 76710-2582
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Country | US
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Telephone | 254-751-9836
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Fax | 254-751-9868
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | JILL FINKE
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Credential |
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Telephone | 210-478-5430
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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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