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General NPI Number Information
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NPI Number | 1326088832
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Entity Type | Organization
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Legal Business Name | IDC OPERATIONS, LP
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 905 E. EUREKA ST
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City | WEATHERFORD
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State | TX
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Zip | 76086-5809
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Country | US
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Telephone | 817-598-8100
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Fax | 817-598-8101
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Provider Business Mailing Address
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Address Line | 905 EUREKA ST
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City | WEATHERFORD
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State | TX
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Zip | 76086-5809
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Country | US
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Telephone | 817-598-8100
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Fax | 817-598-8101
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Authorized Official
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Title or Position | OWNER / CFO
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Name | MR. MICHAEL J. KWEDAR
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Credential |
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Telephone | 817-921-2667
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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 | PENDING SURVEY
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License Number State | TX
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