Healthcare Provider Details

I. General information

NPI: 1609206614
Provider Name (Legal Business Name): HURST AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 PRECINCT LINE RD SUITE 101
HURST TX
76054-3169
US

IV. Provider business mailing address

PO BOX 628767
ORLANDO FL
32862-8767
US

V. Phone/Fax

Practice location:
  • Phone: 817-369-3995
  • Fax:
Mailing address:
  • Phone: 817-369-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACIE GARI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 813-549-2134