Healthcare Provider Details

I. General information

NPI: 1275421158
Provider Name (Legal Business Name): NORTHSTAR VASCULAR SURGERY CENTER OF TEXAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 08/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 S. HULEN
FORT WORTH TX
76132-2687
US

IV. Provider business mailing address

1902 WINDSOR PLACE SUITE 102
FORT WORTH TX
76110-1866
US

V. Phone/Fax

Practice location:
  • Phone: 817-714-8262
  • Fax: 682-241-1922
Mailing address:
  • Phone: 682-207-1700
  • Fax: 682-250-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLADAPO AFOLABI
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 682-207-1700