Organization Name: | LYLE THORSTENSON MD |
NPI Number: | 1134236714 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAMELA R THORSTENSON (ADMINISTRATOR) |
Mailing Address: | 3302 Ne Stallings Dr Nacogdoches |
State: | TX US |
Postal Code: | 759658727 |
Phone Number: | 9365642411 |
Fax Number: | 9365641280 |
NPI Enumeration Date: | 08/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | 000273 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |