Provider Demographics
NPI:1073705653
Name:SOUTHERN PLAINS PAVILION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SOUTHERN PLAINS PAVILION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-937-8900
Mailing Address - Street 1:1324 BROWN ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1324 BROWN ST
Practice Address - Street 2:STE. 100
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1421
Practice Address - Country:US
Practice Address - Phone:972-937-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical