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General NPI Number Information
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NPI Number | 1497882625
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF THE MID-CITIES PA
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 2050 HALL JOHNSON RD STE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-8766
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Country | US
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Telephone | 817-267-2678
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Fax | 817-354-0854
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Provider Business Mailing Address
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Address Line | 2050 HALL JOHNSON RD STE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-8766
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Country | US
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Telephone | 817-267-2678
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Fax | 817-354-0854
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Authorized Official
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Title or Position | PARTNER
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Name | MICHAEL W BRYAN
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Credential | M.D.
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Telephone | 817-267-2678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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