Domain Surgical, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

DOMAIN SURGICAL, LLC

Practice address

2300 Wolflin Ave
Amarillo, TX 79109-1832

Phone

(806) 350-5437

Fax

(806) 350-5438

NPI assigned

Sep 13, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Angela Kathleen Hess

Title

General Director

Phone

(806) 670-5318

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 45C0001690

Legal name

DOMAIN SURGICAL, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 11, 2020

Last certification

Mar 11, 2020

Ownership / control type

Proprietary

Facility address

2300 Wolflin Ave
Amarillo, TX 79109

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536796800000",
    "number": "1780167866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 I 40 W",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791091852",
            "telephone_number": "806-350-5437",
            "fax_number": "806-350-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 WOLFLIN AVE",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791091832",
            "telephone_number": "806-350-5437",
            "fax_number": "806-350-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMAIN SURGICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2018-09-13",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "KATHLEEN",
        "authorized_official_title_or_position": "GENERAL DIRECTOR",
        "authorized_official_telephone_number": "806-670-5318",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Dodson, FNP
• Sydney Dodson
• David Doherty
• Kate Dolezal
• Meagan Nichole Dolezal, CRNA
• Anjelica Dominguez, FNP-C
• Erica Dominguez, PHARMD
• Paige Dominguez
• Donald Hubbard M.D.,PA
• Lonnie Donaldson, PHARMACIST

• Ambulatory Surgical Clinic/Center in Amarillo, TX
• Providers in Amarillo, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.