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General NPI Number Information
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NPI Number | 1295702942
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Entity Type | Organization
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Legal Business Name | GRAPEVINE SURGICARE PARTNERS LTD
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 905 E SOUTHLAKE BLVD STE 200
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8602
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Country | US
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Telephone | 817-410-4300
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Fax | 817-410-4303
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Provider Business Mailing Address
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Address Line | 905 E SOUTHLAKE BLVE STE 200
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8602
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Country | US
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Telephone | 817-410-4300
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Fax | 817-410-4303
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DONITA FLEMING
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Credential |
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Telephone | 202-815-3665
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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 | 007819
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License Number State | TX
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