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General NPI Number Information
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NPI Number | 1871192377
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Entity Type | Organization
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Legal Business Name | SURGERY MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 1808 E AZTEC AVE STE 2
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City | GALLUP
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State | NM
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Zip | 87301-4946
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Country | US
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Telephone | 469-235-5588
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Fax | 866-600-7772
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Provider Business Mailing Address
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Address Line | 1200 E COLLINS BLVD
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City | RICHARDSON
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State | TX
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Zip | 75081-2457
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Country | US
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Telephone | 469-235-5588
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Fax | 866-600-7772
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Authorized Official
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Title or Position | OWNER
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Name | TERRENCE JOHNSON
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Credential |
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Telephone | 469-235-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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