=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942329115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ARTHROSCOPIC OUTPATIENT SURGERY, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5520 N C ST
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-686-2663
-----------------------------------------------------
Fax | 956-686-3045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 720274
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-0274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-686-2663
-----------------------------------------------------
Fax | 956-686-3045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | PATTY SNYDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-686-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------