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General NPI Number Information
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NPI Number | 1700994290
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Entity Type | Organization
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Legal Business Name | UROLOGICAL SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 418 S HENDERSON ST
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City | FORT WORTH
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State | TX
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Zip | 76104-1017
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Country | US
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Telephone | 817-870-9165
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Fax | 817-870-9165
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Provider Business Mailing Address
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Address Line | PO BOX 1958
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City | FORT WORTH
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State | TX
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Zip | 76101
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Country | US
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Telephone | 817-229-4222
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHARLES BAMBERGER
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Credential | DIRECTOR
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Telephone | 817-229-4222
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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 |
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License Number State |
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