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NPI Code Detail

MEDICARE: SOUTH ARLINGTON SURGICAL PROVIDERS, LLC

MEDICARE: SOUTH ARLINGTON SURGICAL PROVIDERS, 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
1261QA1903XAmbulatory Surgical Clinic/Center000391TX
2261QA1903XAmbulatory Surgical Clinic/Center130217TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902844426
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH ARLINGTON SURGICAL PROVIDERS, LLC
Provider Business Mailing Address
First Line : 350 E INTERSTATE 20 STE 200
Second Line :
City : ARLINGTON
State : TX
Zip : 76018-1119
Country : US
Telephone Number : 817-784-6771
Fax Number : 817-784-6743
Provider Business Practice Location Address
First Line : 350 E INTERSTATE 20 STE 200
Second Line :
City : ARLINGTON
State : TX
Zip : 76018-1119
Country : US
Telephone Number : 817-784-6771
Fax Number : 817-784-6743
Authorized Official
Title or Position : CHIEF ADMINISTRATIVE OFFICER
Name : STEPHANIE L. O'NEAL
Credential :
Telephone Number : 817-784-6771
Provider Enumeration Date : 06/04/2006
Last Update Date : 12/30/2019

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Directions to “SOUTH ARLINGTON SURGICAL PROVIDERS, LLC ” Practice Location

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