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General NPI Number Information
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NPI Number | 1528009453
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Entity Type | Organization
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Legal Business Name | TGLP, LP
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1920 MOORES LN SUITE B
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City | TEXARKANA
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State | TX
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Zip | 75503-4610
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Country | US
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Telephone | 903-791-8657
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Fax | 903-791-8650
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Provider Business Mailing Address
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Address Line | 1920 MOORES LN SUITE B
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City | TEXARKANA
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State | TX
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Zip | 75503-4610
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Country | US
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Telephone | 903-791-8657
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Fax | 903-791-8650
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RANDY H POWELL
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Credential |
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Telephone | 903-792-8030
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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 | 008336
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License Number State | TX
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