Healthcare Provider Details

I. General information

NPI: 1326088832
Provider Name (Legal Business Name): IDC OPERATIONS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E. EUREKA ST
WEATHERFORD TX
76086-5809
US

IV. Provider business mailing address

905 EUREKA ST
WEATHERFORD TX
76086-5809
US

V. Phone/Fax

Practice location:
  • Phone: 817-598-8100
  • Fax: 817-598-8101
Mailing address:
  • Phone: 817-598-8100
  • Fax: 817-598-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPENDING SURVEY
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL J. KWEDAR
Title or Position: OWNER / CFO
Credential:
Phone: 817-921-2667