MEDICARE: SURGICAL SERVICES GROUP, INC

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1912596495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SERVICES GROUP, INC

Provider Business Mailing Address
First Line	:	2000 E LAMAR BLVD STE 600
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7361
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8611
Country	:	US
Telephone Number	:	817-756-8236
Fax Number	:

Authorized Official
Title or Position	:	NPI ADMINISTRATOR
Name	:	REKHA WAGLE
Credential	:
Telephone Number	:	817-756-8232

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	12/07/2021

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Directions to “SURGICAL SERVICES GROUP, INC ” Practice Location

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