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Organization

FIRST TEAM SURGICAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA NORTHCUTT (MANAGING MEMBER)
(817) 379-5600
Entity
Organization

Contact information

Practice address
1052 SUMMERPLACE LN, SOUTHLAKE, TX 76092-5120
(817) 379-5600
Mailing address
PO BOX 93191, SOUTHLAKE, TX 76092-1191
(817) 379-5600

Taxonomy

Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
605077
TX

Other

Enumeration date
09/16/2016
Last updated
09/20/2016
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