| Organization Name: | FAYETTEVILLE LITHOTRIPTERS, L.P. - LA1 |
| NPI Number: | 1154401669 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA DAVIS (DIRECTOR, CBO) |
| Mailing Address: | 1301 S Capital Of Texas Hwy Suite B200 West Lake Hills |
| State: | TX US |
| Postal Code: | 787466574 |
| Phone Number: | 5123144331 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QL0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Lithotripsy |
| Taxonomy Definition: | |