1992062608 NPI number — THE AC SURGERY CENTER LLC

Table of content: MOLLY ELLEN MANUEL DPT (NPI 1205870128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992062608 NPI number — THE AC SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE AC SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992062608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 NORTH DAVIS STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76012-3202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
181-746-1169
Provider Business Mailing Address Fax Number:
817-275-1401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N DAVIS DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
181-746-1169
Provider Business Practice Location Address Fax Number:
817-275-1401
Provider Enumeration Date:
04/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FRENZEL
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
181-746-1693

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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