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General NPI Number Information
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NPI Number | 1932653268
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Entity Type | Organization
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Legal Business Name | WHITECOAT ENTERPRISES LLC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 1901 LONG PRAIRIE RD SUITE 220-80
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4246
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Provider Business Mailing Address
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Address Line | 1901 LONG PRAIRIE RD SUITE 220-80
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4246
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Authorized Official
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Title or Position | OWNER
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Name | JAROD ROOT
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Credential | OPA-C
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Telephone | 214-227-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1154
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License Number State | TX
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