Provider Demographics
NPI:1649853532
Name:LOT 108 SERVICES PLLC
Entity type:Organization
Organization Name:LOT 108 SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-943-9776
Mailing Address - Street 1:3060 COMMUNICATIONS PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8492
Mailing Address - Country:US
Mailing Address - Phone:972-943-9779
Mailing Address - Fax:972-943-9776
Practice Address - Street 1:3060 COMMUNICATIONS PKWY STE 201
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8492
Practice Address - Country:US
Practice Address - Phone:972-943-9779
Practice Address - Fax:972-943-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty