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General NPI Number Information
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NPI Number | 1720315393
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Entity Type | Organization
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Legal Business Name | WALTHALL SURGICAL CENTER PLLC
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 301 JENNY GEORGE LN
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City | SWEETWATER
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State | TX
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Zip | 79556-7152
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Country | US
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Telephone | 325-236-8886
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Fax | 325-236-8861
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Provider Business Mailing Address
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Address Line | 301 JENNY GEORGE LN
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City | SWEETWATER
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State | TX
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Zip | 79556-7152
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Country | US
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Telephone | 325-236-8886
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Fax | 325-236-8861
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. ELLEN D WALTHALL
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Credential | M.D.
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Telephone | 325-236-8886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J0343
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License Number State | TX
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