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General NPI Number Information
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NPI Number | 1033399803
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SURGICAL CENTER OF FT. WORTH, L.L.P
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 975 HASKELL ST
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City | FORT WORTH
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State | TX
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Zip | 76107-2653
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Country | US
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Telephone | 817-570-0200
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Fax | 817-570-0280
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Provider Business Mailing Address
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Address Line | 975 HASKELL ST
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City | FORT WORTH
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State | TX
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Zip | 76107-2653
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Country | US
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Telephone | 817-570-0200
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Fax | 817-570-0280
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TONI WILSON
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Credential | RN MSN CASC
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Telephone | 817-570-0203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 008484
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License Number State | TX
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