Organization
FAYETTEVILLE LITHOTRIPTERS LP - VIRGINIA 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATANYA CASTILE (PAYER RELATIONS)
(847) 544-5939
Entity
Organization
Contact information
Practice address
1990 STEAM WAY STE A102, ROUND ROCK, TX 78665-2233
(877) 465-4845
(512) 872-5105
Mailing address
1990 STEAM WAY STE A102, ROUND ROCK, TX 78665-2233
(877) 465-4845
(512) 872-5105
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
—
—
261QL0400X
Lithotripsy Clinic/Center
Primary
—
—
Other
Enumeration date
10/17/2006
Last updated
07/01/2024
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