Basic Information
| Provider Information | |||||||||
| NPI: | 1972941714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEGENT OUTPATIENT SURGERY EULESS, LLC | ||||||||
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| OtherOrganizationName: | LEGENT INTERVENTIONAL PAIN CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1707 MARKET PL STE 300 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750638046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174211066 | ||||||||
| FaxNumber: | 8175071800 | ||||||||
| Practice Location | |||||||||
| Address1: | 461 WESTPARK WAY | ||||||||
| Address2: | |||||||||
| City: | EULESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760403957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175533627 | ||||||||
| FaxNumber: | 8175533626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2013 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | FOWLER | ||||||||
| AuthorizedOfficialFirstName: | JORDAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 8174211066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.