Provider Demographics
NPI:1295202612
Name:EVEXIAS METRITA - COLUMBIA LLC
Entity Type:Organization
Organization Name:EVEXIAS METRITA - COLUMBIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SUTHERLAND
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-296-4560
Mailing Address - Street 1:920 S KIMBALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9019
Mailing Address - Country:US
Mailing Address - Phone:817-296-4560
Mailing Address - Fax:817-796-1678
Practice Address - Street 1:2900 TRIMBLE RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7180
Practice Address - Country:US
Practice Address - Phone:817-296-4560
Practice Address - Fax:817-796-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical