Provider Demographics
NPI:1598197410
Name:STONEBRIDGE FIRST ASSIST
Entity Type:Organization
Organization Name:STONEBRIDGE FIRST ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-547-0047
Mailing Address - Street 1:8865 SYNERGY DR
Mailing Address - Street 2:#101
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6506
Mailing Address - Country:US
Mailing Address - Phone:972-547-0047
Mailing Address - Fax:972-547-0065
Practice Address - Street 1:8865 SYNERGY DR
Practice Address - Street 2:#101
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6506
Practice Address - Country:US
Practice Address - Phone:972-547-0047
Practice Address - Fax:972-547-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty