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General NPI Number Information
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NPI Number | 1639146541
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Entity Type | Organization
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Legal Business Name | CENTENNIAL ASC, LLC
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 4401 COIT RD SUITE 100
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 214-619-0120
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Fax | 214-619-0121
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Provider Business Mailing Address
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Address Line | 4401 COIT RD SUITE 100
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City | FRISCO
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State | TX
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Zip | 75035-0500
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Country | US
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Telephone | 214-619-0120
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Fax | 214-619-0121
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Authorized Official
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Title or Position | OFFICER / 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 | 008203
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License Number State | TX
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