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General NPI Number Information
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NPI Number | 1669673828
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL SURGICAL CARE, LP
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 6501 BLANCO RD
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6627
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Country | US
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Telephone | 956-554-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 N EXPRESSWAY 83 STE 3
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City | BROWNSVILLE
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State | TX
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Zip | 78521
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Country | US
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Telephone | 956-554-7733
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | IGOR KOZLIK
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Credential |
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Telephone | 956-554-7733
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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 | 007132
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License Number State | TX
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