=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699649087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HART SURGICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2025
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 N PRESTON RD STE A
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-8653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-750-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 N PRESTON RD STE A
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-8653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-750-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JOHN CANDELARIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-325-6217
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------