Provider Demographics
NPI:1679082721
Name:LIVE AGAIN SURGICAL
Entity type:Organization
Organization Name:LIVE AGAIN SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-729-6584
Mailing Address - Street 1:8865 DAVIS BLVD
Mailing Address - Street 2:100A
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248
Mailing Address - Country:US
Mailing Address - Phone:817-431-1059
Mailing Address - Fax:817-431-1567
Practice Address - Street 1:8865 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0322
Practice Address - Country:US
Practice Address - Phone:817-431-1059
Practice Address - Fax:817-431-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty