Healthcare Provider Details

I. General information

NPI: 1497882625
Provider Name (Legal Business Name): SURGICAL ASSOCIATES OF THE MID-CITIES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 HALL JOHNSON RD STE 200
GRAPEVINE TX
76051-8766
US

IV. Provider business mailing address

2050 HALL JOHNSON RD STE 200
GRAPEVINE TX
76051-8766
US

V. Phone/Fax

Practice location:
  • Phone: 817-267-2678
  • Fax: 817-354-0854
Mailing address:
  • Phone: 817-267-2678
  • Fax: 817-354-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W BRYAN
Title or Position: PARTNER
Credential: M.D.
Phone: 817-267-2678