Healthcare Provider Details

I. General information

NPI: 1699460295
Provider Name (Legal Business Name): JOURNEY SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 WASHBURN AVE APT A
FT WORTH TX
76107-4055
US

IV. Provider business mailing address

3812 WASHBURN AVE APT A
FT WORTH TX
76107-4055
US

V. Phone/Fax

Practice location:
  • Phone: 321-591-4999
  • Fax:
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JANICE COBRAND
Title or Position: OWNER
Credential: CSFA
Phone: 214-227-2457