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NPI Code Detail

MEDICARE: MODERN SURGERY CENTER OF FORT WORTH

MEDICARE: MODERN SURGERY CENTER OF FORT WORTH
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
1208200000XPlastic Surgery Physician

General Provider Information

NPI Number : 1982349080
Entity Type Code : Organization
Provider Name (Legal Business Name) : MODERN SURGERY CENTER OF FORT WORTH
Provider Business Mailing Address
First Line : 3455 LOCKE AVE STE 320
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-5747
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3416 LOVELL AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-5718
Country : US
Telephone Number : 817-228-4315
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MRS. CORTNI CAMPBELL
Credential : RN
Telephone Number : 940-389-6207
Provider Enumeration Date : 05/03/2022
Last Update Date : 05/03/2022

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Directions to “MODERN SURGERY CENTER OF FORT WORTH ” Practice Location

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