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General NPI Number Information
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NPI Number | 1649252883
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Entity Type | Organization
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Legal Business Name | FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 3610 N UNIVERSITY DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2539
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Country | US
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Telephone | 936-560-9599
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Fax | 936-560-6933
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Provider Business Mailing Address
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Address Line | 3610 N UNIVERSITY DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2539
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Country | US
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Telephone | 936-560-9599
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Fax | 936-560-6933
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | CARAH GODINEZ
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Credential |
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Telephone | 817-705-6517
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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 | 007238
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License Number State | TX
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