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General NPI Number Information
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NPI Number | 1578530226
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SURGICAL CENTER OF FT. WORTH LLP
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 750 12TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-2531
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Country | US
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Telephone | 817-529-2620
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Fax | 817-877-1292
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Provider Business Mailing Address
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Address Line | 750 12TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-2531
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Country | US
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Telephone | 817-529-2620
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Fax | 817-877-1292
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Authorized Official
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Title or Position | MEDICARE 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 | 130267
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License Number State | TX
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