Organization
TEXAS INDEPENDENT FIRST ASSIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA MAUREEN MANTLE LSA (OWNER)
(940) 206-1069
Entity
Organization
Contact information
Practice address
1901 FM 718, AURORA, TX 76078-5213
(940) 206-1069
Mailing address
PO BOX 129, RHOME, TX 76078-0129
(940) 206-1069
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
04/05/2022
Last updated
07/18/2024
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