Basic Information
| Provider Information | |||||||||
| NPI: | 1306804612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONE STAR ENDOSCOPY, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 277417 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303847417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173373671 | ||||||||
| FaxNumber: | 8173373620 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 BEAR CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | KELLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762482500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173373671 | ||||||||
| FaxNumber: | 8173373620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SABLYAK | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | PATRICIA | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 2155899001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 8353 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | BL9674400 | 01 | DEA | OTHER | 70728 | 01 | AAAHC CERTIFICATION | OTHER |