Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Ambulatory Surgical |
261QA1903X | 49 | Ambulatory Surgical Center | |
Clinical Medical Laboratory |
291U00000X | 69 | Clinical Laboratory |
| NPI # | 1437636636 |
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| LBN Legal business name | CCRM DFW, LLC | ||||||||
| Authorized official | JON PARDEW - (CEO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 07/20/2018 | ||||||||
| Last updated | 07/25/2018 - About 8 years ago | ||||||||
| Identifiers |
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