Provider Demographics
NPI:1215127733
Name:UVALDE SURGICAL CLINIC
Entity type:Organization
Organization Name:UVALDE SURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:NWOSU
Authorized Official - Middle Name:OSARO
Authorized Official - Last Name:NGOFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-278-1692
Mailing Address - Street 1:1025 GARNER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4809
Mailing Address - Country:US
Mailing Address - Phone:830-278-1692
Mailing Address - Fax:830-591-0623
Practice Address - Street 1:1025 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4809
Practice Address - Country:US
Practice Address - Phone:830-278-1692
Practice Address - Fax:830-591-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3821208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG73383Medicare UPIN