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General NPI Number Information
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NPI Number | 1841662087
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Entity Type | Organization
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Legal Business Name | GAINSVILLE ALLERGY, ENT AND PLASTIC SURGERY
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 1902 HOSPITAL BLVD STE C
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City | GAINESVILLE
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State | TX
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Zip | 76240-2008
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Country | US
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Telephone | 940-612-8850
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Fax | 940-612-8856
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Provider Business Mailing Address
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Address Line | 1902 HOSPITAL BLVD STE C
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City | GAINESVILLE
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State | TX
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Zip | 76240-2008
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Country | US
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Telephone | 940-612-8850
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Fax | 940-612-8856
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Authorized Official
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Title or Position | DIRECTOR
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Name | LARRY W NELSON SR.
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Credential |
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Telephone | 940-612-8764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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