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General NPI Number Information
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NPI Number | 1689618704
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Entity Type | Organization
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Legal Business Name | FOUNDATION SURGERY AFFILLIATE OF GRAYSON COUNTY, LLC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 3603 CALAIS DRIVE
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City | SHERMAN
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State | TX
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Zip | 75090
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Country | US
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Telephone | 903-813-3700
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Fax | 903-813-3701
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Provider Business Mailing Address
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Address Line | PO BOX 20603
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City | OKLAHOMA CITY
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State | OK
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Zip | 73156-0603
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Country | US
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Telephone | 405-608-1700
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Fax | 405-608-1817
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Authorized Official
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Title or Position | CLINICAL MANAGER/ADMINISTRATOR
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Name | MRS. DEANN SUTTON
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Credential |
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Telephone | 903-813-3700
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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 | 008266
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License Number State | TX
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