Basic Information
| Provider Information | |||||||||
| NPI: | 1134573520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOL FIRST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 MILLER RD | ||||||||
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| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750885604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142272457 | ||||||||
| FaxNumber: | 2147640880 | ||||||||
| Practice Location | |||||||||
| Address1: | 6544 E MEDALIST CIR | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750232847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142272457 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | GARRICK | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | SURGICAL FIRST ASSIST | ||||||||
| AuthorizedOfficialTelephone: | 2142272457 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Medical-Surgical |
No ID Information.