Provider Demographics
NPI:1053676544
Name:SLSP PLLC
Entity Type:Organization
Organization Name:SLSP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-776-5900
Mailing Address - Street 1:611 W HWY 6
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7544
Mailing Address - Country:US
Mailing Address - Phone:254-776-5900
Mailing Address - Fax:254-776-5921
Practice Address - Street 1:611 W HWY 6
Practice Address - Street 2:SUITE 108
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7544
Practice Address - Country:US
Practice Address - Phone:254-776-5900
Practice Address - Fax:254-776-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty