629 Twelve Oaks. LLC

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

Legal business name

629 TWELVE OAKS. LLC

Practice address

4516 Lovers LN
St 331
Dallas, TX 75225-6925

Phone

(214) 315-6432

Fax

(214) 317-4667

NPI assigned

Jun 24, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bridget Brady, MD

Title

Owner

Phone

(214) 315-6432

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1568844751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 LOVERS LN",
            "address_2": "ST 331",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256925",
            "telephone_number": "214-315-6432",
            "fax_number": "214-317-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 LOVERS LN",
            "address_2": "ST 331",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256925",
            "telephone_number": "214-315-6432",
            "fax_number": "214-317-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "629 TWELVE OAKS. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-24",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-315-6432",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.