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Ambulatory Health Care Facilities Clinic/Center

Provider NPI: 1558872994

Organization Information:
Organization is Subpart
Authorized Official:  CONOR  BUTTS  PRESIDENT AND COO  469-995-8416

Practice Location:
1000 N WEST ST STE 1200  WILMINGTON, DE 19801-1058 US
Tel: 302-449-6471  Fax: 866-279-4704

Business Mailing Address:
4545 FULLER DR STE 100  IRVING, TX 75038-6509 US
Tel: 469-995-8416  Fax: --

NPI Information:
NPI: 1558872994
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N261Q00000XAmbulatory Health Care Facilities
N261QS1200XAmbulatory Health Care Facilities
Physiological Laboratory

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 293D00000X





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