NPI age
21 years
Enumerated 2005-05-23
Across 1647 active clinic/center providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | HH1519 | BLUE CROSS BLUE SHIELD |
| 01 (TX) | 007965 | STATE ASC LICENSE NUMBER |
| 05 (TX) | 0879769 |
Single-site organization. Only one practice location on file.
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