MEDICARE: CITYVIEW SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	8142	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659378800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITYVIEW SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	6551 HARRIS PKWY STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6105
Country	:	US
Telephone Number	:	817-346-3800
Fax Number	:	817-346-3815

Provider Business Practice Location Address
First Line	:	6551 HARRIS PKWY
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6102
Country	:	US
Telephone Number	:	817-346-3800
Fax Number	:	817-346-3815

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	DONITA FLEMING
Credential	:
Telephone Number	:	202-815-3665

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	09/15/2025

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