Basic Information
| Provider Information | |||||||||
| NPI: | 1952412439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAXAHACHIE SURGERY PAVILION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 BROWN ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | WAXAHACHIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751651421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729376277 | ||||||||
| FaxNumber: | 9729376288 | ||||||||
| Practice Location | |||||||||
| Address1: | 1324 BROWN ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | WAXAHACHIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751651421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729376277 | ||||||||
| FaxNumber: | 9729376288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSSINESS OFFICE MGR. | ||||||||
| AuthorizedOfficialTelephone: | 9729376277 | ||||||||
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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 | 007799 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.