Provider Demographics
NPI:1780167866
Name:DOMAIN SURGICAL, LLC
Entity type:Organization
Organization Name:DOMAIN SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-670-5318
Mailing Address - Street 1:2455 I 40 W
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1852
Mailing Address - Country:US
Mailing Address - Phone:806-350-5437
Mailing Address - Fax:806-350-5438
Practice Address - Street 1:2300 WOLFLIN AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1832
Practice Address - Country:US
Practice Address - Phone:806-350-5437
Practice Address - Fax:806-350-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical