Organization
WICHITA FALLS ENDOSCOPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACI KOETTER (BUSINESS OFFICE MANAGER)
(940) 761-9034
Entity
Organization
Contact information
Practice address
1500 9TH ST, WICHITA FALLS, TX 76301-4323
(940) 761-9034
Mailing address
1500 9TH ST, WICHITA FALLS, TX 76301-4323
(940) 761-9034
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
008194
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008194
STATE LICENSE
TX
Enumeration date
06/20/2005
Last updated
08/22/2020
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